Pregnant Patient With Severe Stricturing and Fistulizing CD
What is the recommended strategy for managing a patient with a history of severe stricturing and fistulizing Crohn's disease (now in remission on maintenance infliximab and 6-mercaptopurine) who wants to get pregnant? Should these medications be stopped before pregnancy, and if so, how long before?

The outcome of pregnancy in patients with inflammatory bowel disease (IBD) is very much related to the degree of activity of disease at conception. If the patient has demonstrated that she needs 6-mercaptopurine and/or infliximab to maintain remission, then the medication(s) should be continued throughout the pregnancy.

6-mercaptopurine is a category D medication and should only be used in pregnancy if the benefits to the mother far outweigh the risk to the fetus. Recent historical cohort studies have shown that the risk to the fetus is very low in IBD patients. If 6-mercaptopurine is to be stopped prior to conception, contraception should be in place for approximately 1 month. Infliximab is a category B drug and is thought to be safe. However, the manufacturer does not recommend use during pregnancy. A manufacturer-maintained database of inadvertent use during pregnancy in more than 60 women has not shown an inordinate risk of prematurity or birth defects.