Dr Mahadevan discusses the key findings of the PIANO Helmsley global consensus on pregnancy and inflammatory bowel disease, including preconception counseling, the safety of IBD medications during pregnancy and lactation, and more.

Uma Mahadevan, MD, is a professor of medicine and director of the Center for Colitis and Crohn’s Disease at the University of California San Francisco, and principal investigator of the PIANO study of pregnancy and IBD. S

TRANSCRIPT:

Hello, my name is Uma Mahadevan, professor of medicine from the University of California, San Francisco, coming to you from DDW 2024, where we presented the preliminary results of the Piano Helmsley Global Pregnancy Consensus Conference. This project is over one year in the making and involves 50 people from around the world: IBD specialists, teratologists, maternal fetal medicine specialists, patient advocates, and surgeons. After an intense literature review and review of GRADE data, as well as a first round of RAND voting, we had our first meeting Thursday and Friday prior to DDW and voted on the final consensus statements.

Some of the findings are expected. We recommend that women with inflammatory bowel disease receive preconception counseling and are ideally in remission for 3 to 6 months prior to considering conception. We also recommend that medications that are considered low risk for use during pregnancy, such as 5-ASAs, sulfazalazine, thiopurines, and all monoclonal antibodies are continued during preconception, pregnancy, and during lactation. For small molecules, we recommend that they are avoided ideally for at least 1 month and for some of the medications 3 months prior to attempting conception. They should also be avoided during lactation.

Some of the new findings of the Global Consensus Conference were that rotavirus vaccine can be given on schedule. even among patients exposed to biologic therapy in utero. We also recommend that all women with IBD are followed as hig- risk pregnancies and that care may vary based on the resources of the country in which they live.

We also recommend that all women with IBD are started on aspirin by 12 to 16 weeks of pregnancy. This is to reduce the risk of preterm preeclampsia. Women with IBD should also be monitored for VTE risk, both before delivery as well as in the postpartum.

Another novel finding of the consensus conference is that women with IBD may breastfeed on all of the monoclonal antibodies, including the newer IL -23s for which there is not yet human data. The recommendation to continue them through pregnancy and lactation is based on placental physiology, as well as on the physiology of monoclonal antibody transfer in breast milk.

This Global Consensus Conference took into account the needs of our patients and our providers in the global community. And in the discussion, there will be caveats. and explanations for where the data came from to support our recommendations and we thank the global community of physicians and patients who participated in this study.