American Board of Internal Medicine (ABIM) Certification Practice Exam

In treating Crohn's disease in a pregnant patient, which medication is preferred?

1. Glucocorticoids

2. Anti-tumor necrosis factor

3. Thiopurine medications

4. Non-steroidal anti-inflammatory drugs

The correct answer is: Anti-tumor necrosis factor

In the context of treating Crohn's disease during pregnancy, anti-tumor necrosis factor (anti-TNF) medications are preferred due to their efficacy in controlling disease activity and safety profile. These biologic agents, such as infliximab and adalimumab, have been shown to be effective in maintaining remission in women with Crohn's disease and are considered safe to use during pregnancy. Research indicates that anti-TNF therapies do not increase the risk of major birth defects and may even have positive maternal and fetal outcomes when the mother's disease is well-controlled. Maintaining disease control during pregnancy is crucial as active disease can lead to adverse outcomes for both the mother and the fetus. Furthermore, anti-TNF medications have a long half-life and can remain in circulation, which can be beneficial for pregnant patients who may experience changes in drug metabolism during pregnancy. While glucocorticoids can also be effective in managing flare-ups of Crohn's disease, they are often considered to be a second-line option due to potential risks of maternal and fetal complications when used long-term. Thiopurine medications, while useful for maintenance therapy in Crohn's disease, also carry risks and may be associated with fetal abnormalities if used in the first trimester. Non