對於發炎性腸道疾病懷孕婦女的治療與建議

10.6666/ClinMed.202106_87(6).0064

許晏慈；薛祐傑；方冠傑

發炎性腸道疾病（inflammatory bowel disease, IBD） ； 懷孕（pregnancy） ； 用藥（medication）

臨床醫學月刊

87卷6期（2021 / 06 / 25）

388 - 399

繁體中文

發炎性腸道疾病（inflammatory bowel disease, IBD）是兩種慢性腸道發炎疾病的統稱，包含潰瘍性結腸炎（ulcerative colitis, UC）及克隆氏症（Crohn's disease, CD），其機轉尚未完全釐清，雖然先前有基因經研究證實和IBD有關，目前仍認為免疫系統失調造成腸道微環境的變化才是導致IBD的主要因素，包含飲食抽菸等等。IBD患者的生育能力和一般婦女沒有不同，然而當患者為活動性疾病期時有較高的早產或流產風險，因此建議在疾病緩解期受孕，必要的時候採取適當避孕措施，由於IBD患者靜脈血栓風險比一般人高，子宮內避孕器是比賀爾蒙避孕藥物更適當的選擇，懷孕期間除了營養補充包含維生素及葉酸、監測疾病活動度及監測血清藥物濃度以達到疾病控制，目前大部分藥物對IBD懷孕婦女相對安全，除了部分小分子藥物因臨床研究稀少須斟酌使用，生物製劑（biologics）需於分娩前調整劑量以降低藥物穿過胎盤的濃度，懷孕期間若疾病復發需利用影像、內視鏡或手術來協助診斷，並調整用藥，分娩時除非先前有過直腸陰道瘻管（rectovaginal fistula））或迴腸儲袋肛管吻合術（ileal pouch-anal anastomosis, IPAA）可能需選擇剖腹產，一般來說，大多數情況下都能順利自然產。

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