Twitter debate: controversies in pregnancy in IBD and liver disease

The August 2021 #FGDebate discussed controversies in pregnancy in inflammatory bowel disease (IBD) and liver disease. The debate covered the difficult topics of when to perform endoscopy and other investigations, tackling treatment in active IBD, distinguishing normal versus pathological liver parameters and management of acute fatty liver disease in pregnancy. The debate rendered a very educational and stimulating discussion from across the world, including the UK, USA, Canada and Australia, generating over 300 tweets and 700 000 impressions. In this article, we will expand on the key discussion points from the debate. ### Managing patients with IBD during pregnancy Managing IBD during the pregnancy can be challenging as the welfare of both mother and fetus need to be taken into consideration. Controlling disease activity is crucial as active IBD is associated with higher risks of adverse pregnancy outcomes for both mother and fetus.1 Of concern, a recent study reported that 50% of women with IBD were worried about infertility, one-quarter believed they would rather tolerate symptoms than expose the fetus to their treatment, one-third believed that any medications given for IBD would be dangerous for their unborn child and three-quarters were concerned about transmitting the disease to their offspring.2 It is unsurprising then that voluntary childlessness (person or couple who choose not to have children) has been recorded at 17% for these patients (compared with 6% for the general population).3 4 Thus, it is crucial for patients to understand the importance of controlling their disease and maintaining remission by continuing their medication. ### Undergoing lower Gastrointestinal (GI) endoscopy and other investigations in pregnancy Recent evidence suggests that both flexible sigmoidoscopy and colonoscopy are safe during the pregnancy for both mother and fetus at any stage of pregnancy.5 If clinically indicated, this investigation should not be deferred as there may be greater implications in leaving these patients untreated. During the procedure, pregnant patients should be …