Methods (differential diagnosis, investigations, and
treatment):
Tofacitinib was ceased immediately. She and her partner were consulted
regarding the potential foeticidal and teratogenic effects of
tofacitinib and the lack of human studies on pregnancy outcomes. They
decided to continue the pregnancy. She was commenced on folic acid and
oral pre-conception multi-vitamin supplement tablets and referred to a
high-risk pregnancy clinic. After cessation of tofacitinib, despite
being in clinical remission, a follow-up faecal calprotectin had
increased to 2,000 ug/g. An unsedated flexible sigmoidoscopy showed Mayo
1 left-sided colitis at eight weeks gestation. Prednisolone 30mg daily
was commenced. Due to her previous remission on vedolizumab and the
recent introduction of subcutaneous maintenance vedolizumab, she agreed
to intravenous induction of 300mg at weeks 0, 2 and 6, followed by
subcutaneous vedolizumab 108mg every other week. At eleven weeks of
gestation, she remained in clinical remission on prednisolone 20mg
daily, and her faecal calprotectin decreased to 62ug/g. First-trimester
non-invasive prenatal tests for foetal aneuploidy and nuchal
translucency examination were unremarkable. Prednisolone was
successfully tapered over two months, and she continued subcutaneous
vedolizumab throughout her pregnancy.