Quick Shot #1 Answer

Answer:  Stop methotrexate at least 3 months prior to attempting conception and continue infliximab throughout pregnancy

 

Several large studies across disease states have shown infliximab safety in pregnancy.  The level of infliximab at delivery is not associated with adverse events so it is not necessary to hold dosing at any point. Many physicians will hold the dose within 1-2 weeks of the due date until after delivery, but anything earlier than that is not indicated. Methotrexate is an abortifacient and teratogen and should not be used during pregnancy. As she is currently in remission on stable therapy, she can successfully conceive and deliver a healthy child.

 

Mahadevan U, et al. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. 2019 Apr;156(5):1508-1524. doi: 10.1053/j.gastro.2018.12.022. Epub 2019 Jan 16. PMID: 30658060.