Keeping the ‘Enemy’ of IBD at Bay During Pregnancy and Pandemic
This month’s cover story on pregnant women with inflammatory bowel disease covered all the relevant points. The important message is that the “enemy” here is not the medication — it’s the active Crohn’s disease or active ulcerative colitis. Treating the inflammation is of paramount importance, to maximize the chance of good pregnancy outcomes. The physicians interviewed said to develop a plan where you’re continuing the biologic throughout pregnancy. Trying to develop a plan to hold the drug in the last half of pregnancy makes things more complex, so it’s easier for patients and for providers to remember to just continue the biologic throughout pregnancy. There is a safety concern that if you do hold the biologic during the last half or last third of pregnancy, that will increase the risk for postpartum flare. The last thing a new mother needs is a flare of her IBD. It’s better all-around to just continue the medication. The main exceptions to this recommendation are methotrexate, which is totally contraindicated, and then to a lesser extent tofacitinib (Xeljanz, Pfizer) just because we don’t have enough data on it.
Virtual Visits During COVID-19
It’s important to work with local obstetricians during this COVID-19 pandemic. I’ve noticed that some are trying at some point, either earlier in pregnancy or in the second trimester, to conduct visits virtually. But at a certain level the patients will still need to be seen. Both patients and providers seem to be doing a good job at social distancing and minimizing the risk and helping to flatten the curve. Virtual video and phone visits have certainly been helpful in my own practice, but they can get us only so far in providing care. We’re in this dilemma of: we flattened the curve, but we haven’t achieved herd immunity, which is when enough of the population has been exposed/immune that it is no longer spreading. For COVID-19, it has been estimated that herd immunity may occur when 60% to 70% of the population has antibodies to the virus. In most parts of country, we’re not anywhere close to herd immunity. Thus, we have entered this awkward new phase where we have flattened the curve and we probably have enough ventilators and protective equipment to manage it, but how do we re-open society with COVID-19 still present? That’s going to be tricky. At my institution, we’re actually starting to see urgent and semi-urgent patients again. And we’re adjusting to new workflows in the era of the novel coronavirus.
Reduce Anxiety With Information
COVID-19, like many diseases, has instilled anxiety in many because of fear and lack of knowledge. Through our role as healthcare workers we can try to improve knowledge by providing information to our patients. We do this every day in the office, teaching our patients about their gastrointestinal conditions. In the case of our pregnant patients with IBD, we can reduce their fears about the safety of their IBD medication. Fear is based on the unknown. As long as you can provide medical information in a compassionate way, that can go a long way to relieve our patients’ concerns.
Disclosure: Loftus reports he is a consultant for and has received research support from AbbVie, Allergan, Janssen, Takeda and UCB Pharma.