Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education
Table 3
Continuation of commonly used IBD medications for women with IBD during pregnancy by physician training status: a survey of practicing Canadian physicians.
All physicians
Gastroenterologists
Other specialists
General practitioners
value
%
%
%
%
Sulfasalazine and mesalamine
Sulfasalazine
Continue
81/171
47.4
60/91
65.9
3/9
33.3
18/71
25.4
<0.001
Stop
39/171
22.8
23/91
25.3
3/9
33.3
13/71
18.3
Unsure
51/171
29.8
8/91
8.8
3/9
33.3
40/71
56.3
Mesalamine, oral
Continue
118/176
67.0
95/96
99.0
5/10
50.0
18/70
25.7
<0.001
Stop
12/176
6.8
1/96
1.0
0/10
0
11/70
15.7
Unsure
46/176
26.1
0/96
0
5/10
50.0
41/70
58.6
Mesalamine, topical
Continue
121/172
70.3
91/94
96.8
5/10
50.0
25/68
36.8
<0.001
Stop
7/172
4.1
3/94
3.2
0/10
0
4/68
5.9
Unsure
44/172
25.6
0/94
0
5/10
50.0
39/68
57.4
Steroids
Prednisone, oral
Continue
119/175
68.0
81/95
85.3
8/11
72.7
30/69
43.5
<0.001
Stop
32/175
18.3
14/95
14.7
1/11
9.1
17/69
24.6
Unsure
24/175
13.7
0/95
0
2/11
18.2
22/69
31.9
Prednisone, topical
Continue
141/179
78.8
85/96
88.5
8/11
72.7
48/72
66.7
<0.001
Stop
16/179
8.9
9/96
9.4
1/11
9.1
9/72
8.3
Unsure
22/179
12.3
2/96
2.1
2/11
18.2
18/72
25.0
Budesonide, oral
Continue
106/172
61.6
75/93
80.6
4/10
40.0
27/69
39.1
<0.001
Stop
27/172
15.7
12/93
12.9
2/10
20.0
13/69
18.8
Unsure
39/172
22.7
6/93
6.5
4/10
40.0
29/69
42.0
Budesonide, topical
Continue
129/172
75.0
82/92
89.1
6/10
60.0
41/70
58.6
<0.001
Stop
12/172
7.0
7/92
7.6
1/10
10.0
4/70
5.7
Unsure
31/172
18.0
3/92
3.3
3/10
30.0
25/70
35.7
Antibiotics
Ciprofloxacin
Continue
27/176
15.3
21/95
22.1
1/10
10.0
5/71
7.0
0.016
Stop
127/176
72.2
66/95
69.5
9/10
90.0
52/71
73.2
Unsure
22/176
12.5
8/95
8.4
0/10
0
14/71
19.7
Metronidazole
Continue
55/175
31.4
27/95
28.4
3/11
27.3
25/69
36.2
0.003
Stop
96/175
54.9
61/95
64.2
8/11
72.7
27/69
39.1
Unsure
24/175
13.7
7/95
7.4
0/11
0
17/69
24.6
Immunosuppressants
Azathioprine/6-mercaptopurine
Continue
100/175
57.1
84/94
89.4
5/11
45.5
11/70
15.7
<0.001
Stop
46/175
26.3
8/94
8.5
4/11
36.4
34/70
48.6
Unsure
29/175
16.6
2/94
2.1
2/11
18.2
25/70
35.7
Methotrexate
Continue
5/177
2.8
4/96
4.2
0/11
0
1/70
1.4
0.039
Stop
159/177
89.8
90/96
93.8
10/11
90.9
59/70
84.3
Unsure
13/177
2.8
2/96
2.1
1/11
9.1
10/70
14.3
Biologics
Infliximab
Continue
99/178
55.6
87/96
90.6
4/11
36.4
8/71
11.3
<0.001
Stop
39/178
21.9
4/96
4.2
5/11
45.5
30/71
42.3
Unsure
40/178
22.5
5/96
5.2
2/11
18.2
33/71
46.5
Adalimumab
Continue
96/177
54.2
84/95
88.4
4/11
36.4
8/71
11.3
<0.001
Stop
37/177
20.9
3/95
3.2
5/11
45.5
29/71
40.8
Unsure
44/177
24.9
8/95
8.4
2/11
18.2
34/71
47.9
= number of responses falling into the response category; = number of physicians who answered the question. Percentages are calculated using the number of physicians who selected the category response as the numerator and the total number of physicians of that training status who provided a response as the denominator. GI: gastroenterologist, GP: general practitioner, and other: other specialists (general internists and surgeons). IBD: inflammatory bowel disease. Bolded responses are best practice as recommended by expert opinion and guidelines.
