Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education
Table 4
Continuation of commonly used IBD medications for women with IBD during breastfeeding by physician training status: a survey of practicing Canadian physicians.
All physicians
Gastroenterologists
Other specialists
General practitioners
value
%
%
%
%
Sulfasalazine and mesalamine
Sulfasalazine
Continue
71/176
40.3
46/94
48.9
3/10
30.0
22/72
30.6
<0.001
Stop
45/176
25.6
31/94
33.0
4/10
40.0
10/72
13.9
Unsure
60/176
34.1
17/94
18.1
3/10
30.0
40/72
55.6
Mesalamine, oral
Continue
116/179
64.8
91/96
94.8
5/11
45.5
20/72
27.8
<0.001
Stop
11/179
6.1
2/96
2.1
2/11
18.2
7/72
9.7
Unsure
52/179
29.1
3/96
3.1
4/11
36.4
45/72
62.5
Mesalamine, topical
Continue
126/178
70.8
92/96
95.8
5/10
50.0
29/72
40.3
<0.001
Stop
7/178
3.9
2/96
2.1
1/10
10.0
4/72
5.6
Unsure
45/178
25.3
2/96
2.1
4/10
40.0
39/72
54.2
Steroids
Prednisone, oral
Continue
132/180
73.3
88/97
90.7
8/11
72.7
36/72
50.0
<0.001
Stop
21/180
11.7
8/97
8.2
1/11
9.1
12/72
16.7
Unsure
27/180
15
1/97
1.0
2/11
18.2
24/72
33.3
Prednisone, topical
Continue
149/177
84.2
93/96
96.9
9/10
90.0
47/71
66.2
<0.001
Stop
6/177
3.4
3/96
3.1
0/10
0
3/71
4.2
Unsure
22/177
12.4
0/96
0
1/10
10.0
21/71
29.6
Budesonide, oral
Continue
121/173
69.9
84/94
89.4
6/11
54.5
31/68
45.6
<0.001
Stop
17/173
9.8
5/94
5.3
2/11
18.2
10/68
14.7
Unsure
35/173
20.2
5/94
5.3
3/11
27.3
27/68
39.7
Budesonide, topical
Continue
138/173
79.8
87/94
92.6
7/10
70.0
44/69
63.8
<0.001
Stop
11/173
6.4
5/94
5.3
1/10
10.0
5/69
7.2
Unsure
24/173
13.9
2/94
2.1
2/10
20.0
20/69
29.0
Antibiotics
Ciprofloxacin
Continue
51/178
28.7
32/97
33.0
2/11
18.2
17/70
24.3
0.133
Stop
88/178
49.4
44/97
45.4
9/11
81.8
35/70
50.0
Unsure
39/178
21.9
21/97
21.6
0/11
0
18/70
25.7
Metronidazole
Continue
63/176
35.8
30/96
31.3
3/11
27.3
30/69
43.5
0.014
Stop
73/176
41.5
46/96
47.9
8/11
72.7
19/69
27.5
Unsure
40/176
22.7
20/96
20.8
0/11
0
20/69
29.0
Immunosuppressants
Azathioprine/6-mercaptopurine
Continue
87/176
49.4
76/95
80.0
5/11
45.5
6/70
8.6
<0.001
Stop
47/176
26.7
11/95
11.6
4/11
36.4
32/70
45.7
Unsure
42/176
23.9
8/95
8.4
2/11
18.2
32/70
45.7
Methotrexate
Continue
15/176
8.5
13/95
13.7
0/11
0
2/70
2.9
0.004
Stop
122/176
69.3
68/95
71.6
10/11
90.9
44/70
62.9
Unsure
39/176
22.2
14/95
14.7
1/11
9.1
24/70
34.3
Biologics
Infliximab
Continue
92/176
52.3
83/95
87.4
4/11
36.4
5/70
7.1
<0.001
Stop
34/176
19.3
5/95
5.3
5/11
45.5
24/70
34.3
Unsure
50/176
28.4
7/95
7.4
2/11
18.2
41/70
58.6
Adalimumab
Continue
89/176
50.6
80/95
84.2
4/11
36.4
5/70
7.1
<0.001
Stop
33/176
18.2
5/95
5.3
5/11
45.5
23/70
32.9
Unsure
54/176
30.7
10/95
10.5
2/11
18.2
42/70
60.0
= number of responses. 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. Bolded responses are best practice as recommended by expert opinion and guidelines.
