INTESTINE Vol.21 No.2(7)

特集名 小児・妊婦・高齢者に対するIBD診療
題名 炎症性腸疾患が妊娠・胎児に与える影響
発刊年月 2017年 03月
著者 長沼 誠 慶應義塾大学医学部消化器内科
著者 金井 隆典 慶應義塾大学医学部消化器内科
【 要旨 】 炎症性腸疾患は若年に発症し,妊娠・出産などの重要なイベントに影響することが多い.出産を希望する患者への指導,管理を適切に行うためには,炎症性腸疾患や使用する薬剤が妊孕性,妊娠転帰・胎児に与える影響について患者へ適切に伝えることが重要である.妊孕性については非手術例では潰瘍性大腸炎,クローン病ともにコントロール群と差がないが,手術既往歴,活動期肛門病変を有する症例では妊孕性が低下する.疾患と妊娠・出産転帰との関連については,本邦で多施設共同研究が施行され,潰瘍性大腸炎では発症前後で妊娠転帰に差がない一方で,クローン病では発症後で流産や帝王切開を要する割合が高いことが明らかになっている.また妊娠中の再燃は出産転帰や新生児の状態に影響することも報告されている.以上より,妊娠を考慮するときより疾患活動性をコントロールすることが重要であると考えられる.
Theme Treatment for children, pregnant women and elderly patients with IBD
Title Effect of inflammatory bowel disease on pregnancy and infants
Author Makoto Naganuma Division of Gastroenterology and Hepatology, Kieo University School of Medicine
Author Takanori Kanai Division of Gastroenterology and Hepatology, Kieo University School of Medicine
[ Summary ] The onset of inflammatory bowel diseases (IBD) occurrs in younger individuals and the disease course affects critical events in patients' lives, such as pregnancy and delivery. It is critical to appropriately provide information to patients regarding the effects of disease activity and medications on the outcome of fertility, pregnancy outcomes and infants' conditions. The fertility of non-surgical patients with both ulcerative colitis (UC) and Crohn's disease (CD) is comparable to that of control groups. However, infertility is more frequently observed in patients with previous surgical treatment or patients with active perianal lesions. The results of a Japanese multicenter study indicated that pregnancy outcomes after onset of UC were comparable to those before onset of UC. However, rates of spontaneous abortion and caesarean delivery after onset of CD were significantly higher than before onset of CD. Recent studies have also indicated that women with UC and CD are at increased risk of adverse birth outcomes, when they suffer from flares throughout pregnancy. In conclusion, it is critical for physicians to control disease activity in IBD patients to obtain better pregnancy outcomes and infants' health condition.