Case 10

Case Submitted by Uma Mahadevan, MD


A 29-year-old year old woman with a 3-year history of ulcerative colitis presents to the office to discuss a pregnancy after a recent miscarriage. 

She has left sided UC in remission for the last 4 months on mesalamine 2.4 gm daily.  She takes it intermittently and has had 1 flare per year that resolves with taking her medication regularly but most recently needed her first course of prednisone. 

She has been off prednisone for the last 4 months and had a spontaneous abortion at 8 weeks gestation around the time of the start of her most recent flare. She states that since then, she has been regularly taking the mesalamine and is asymptomatic. She asks if she needs to continue her medication during pregnancy and what else she needs to do to prepare.

Physical Exam: Well appearing, well nourished woman in no distress

What would you counsel at this time?
Check blood work including vitamin D and iron
Perform a colonoscopy or flexible sigmoidoscopy to confirm endoscopic response
Recommend she continue her mesalamine daily
Refer her to a high risk obstetrician (maternal fetal medicine – MFM) once pregnant

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