Budesonide Induction and Maintenance Therapy for Crohnʼs Disease during Pregnancy: 1191

Purpose: There is no standard approach for the medical management of Crohn's Disease (CD) during pregnancy with limited data regarding the use of budesonide (Entocort® EC, AstraZeneca; FDA pregnancy category C) for induction and/or maintenance of remission. We reviewed a tertiary referral IBD center's database to evaluate outcomes of budesonide use during pregnancy. Methods: Pregnant CD pts between 2001–2005 who received budesonide comprised the study population. Data on tx of CD, budesonide dosage and duration, concomitant medications, clinical course, pregnancy complications, and birth outcome were recorded. Results: Among 460 CD female, there were 43 pregnancies in 28 women. 4 pts were treated with budesonide induction and 3 received long-term maintenance. Symptoms of partial small bowel obstruction (SBO) prompted tx in all 4 pts. Pt 1: previously resected SB CD pt on azathioprine(AZA) received budesonide 6 mg qd for a 1 month prior to surgery for lysis of adhesions during 1st trimester. Remaining pregnancy was uneventful with vaginal term delivery. Pt 2: (SB/LB CD) initiated budesonide 6 mg qd following resolution of a SBO at 6 wks which required hospitalization and IV corticosteroids. She remained on budesonide but experienced repeat SBO when the drug was tapered at 26 wks of pregnancy, again requiring hospitalization with parenteral steroids and fluids. The pt was continued on budesonide 6 mg qd until spontaneous vaginal delivery at term. Pt 3: (SB/LB CD) with history of SBO had discontinued methotrexate prior to pregnancy and was maintained on budesonide 6 mg qd, prior to and throughout pregnancy, delivering at 36 wks with C-section. Pt 4 has SB/LB CD requiring AZA and was treated with budesonide 6 mg qd from 15 wks gestation until term delivery, after initiating drug due to SBO. All 4 delivered children are healthy to date. Conclusions: We report a series of pregant women who received budesonide for the tx of small bowel CD. Induction and maintenance therapy was well toleratedand effective in all pts. This limited data suggests that oral budesonide may be considered in CD women who experience small bowel disease during pregnancy to achieve optimal outcome for both mother and baby.