Ciprofloxacin exposure and adverse pregnancy outcomes: a Danish nationwide cohort study

Evaluation and management of ileal pouch-anal anastamosis (IPAA) complications in pregnancy, and the impacts of an IPAA on fertility

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) remains the preferred surgical option for medically refractory ulcerative colitis. Management of individuals with an IPAA prior to and during pregnancy presents challenges that can have serious consequences. Infertility, mechanical obstructive and inflammatory pouch complications are frequently encountered in pregnant women with an IPAA. Mechanical obstructions occur due to a variety of underlying aetiologies, including stricturing disease, adhesions and pouch twists. Conservative management of such obstructions often results in resolution of symptoms without a need for endoscopic or surgical intervention, although endoscopic decompression may be attempted in isolation or as a bridge to definitive surgical intervention. Parenteral nutrition, and early delivery, may also be necessary. Faecal calprotectin and intestinal ultrasound, both of which are accurate in pregnancy, are useful in the setting of suspected inflammatory pouch complications, in some circumstances allowing for avoidance of pouchoscopy. Penicillin-based antimicrobials can be considered first line in pregnancy for the management of pouchitis and pre-pouch ileitis, and biologics can be safely instituted in the setting of refractory disease or suspected Crohn's disease-like inflammation of the pouch or pre-pouch ileum. Pragmatism, clear patient communication and multidisciplinary discussion are essential in approaching pregnant women with complications of an IPAA, particularly given the lack of definitive evidence to guide therapeutic decisions.

[Should fluoroquinolones be feared during pregnancy and breastfeeding?]

Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin) are antibiotics which pharmacological and therapeutic advantages resulted in a large use, now restricted because of resistances emergence and adverse effect risk. For pregnant or breastfeeding women they still are a cause of concern, based on the joint toxicity described in children directly treated, thus limiting their use in these populations. However, the data about exposed pregnancies published over time have not so far confirm these fears and allow, when a fluoroquinolone is clearly indicated, not to deprive pregnant patients of the therapeutic benefit of these important antibiotics and to envisage their use whatever the term of the pregnancy, within the current scope of their prescription. During breastfeeding the use of some of them can be considered.