Safety of Immunomodulators and Anti-TNF Therapy in Pregnancy.

OPINION STATEMENT: Biologics have proved to be extremely effective therapies for active, difficult to treat ulcerative colitis and Crohn's disease. Given that active disease appears to be what drives worse outcomes in conception and pregnancy, understanding of the potential risks of continued biologic therapy during pregnancy is important. Knowledge of the mechanisms of placental transfer helps clinicians explain to patients the timing of potential cessation of therapy, and the ongoing data collection from the efforts of the Crohn's and Colitis Pregnancy Registry have helped immensely to move this field forward. The body of evidence for use of thiopurines as well has supported their continued use during pregnancy in patients, despite their category D rating. Family planning and counseling have come a long way with our efforts in understanding that the real enemy is active inflammation, not the therapies we use to treat it.