American Board of Internal Medicine (ABIM) Certification Practice Exam

During pregnancy, what is the suggested management for patients receiving therapy for ulcerative colitis?

1. Stop all medications during pregnancy

2. Use corticosteroids only

3. Continue azathioprine maintenance therapy

4. Switch to biologics

The correct answer is: Continue azathioprine maintenance therapy

Continuing azathioprine maintenance therapy during pregnancy is supported by evidence, as it is considered to have a relatively low risk when compared to the risks of uncontrolled disease. Maintaining remission for ulcerative colitis is crucial during pregnancy, as active disease can lead to adverse pregnancy outcomes, including premature birth, low birth weight, and the need for cesarean delivery. Azathioprine has been studied in pregnant populations, and while there are some concerns about potential risks, such as birth defects, the overall benefits of disease control often outweigh these risks. When patients are stable on azathioprine prior to conception, it is generally encouraged to maintain the therapy throughout pregnancy. In contrast, discontinuing all medications can lead to a flare of ulcerative colitis, which poses a greater risk to both the mother and fetus. While corticosteroids are sometimes used to manage active disease, they are not necessarily the first-line maintenance therapy and are typically reserved for acute exacerbations. Switching to biologics might be considered if the patient has not been effectively managed on azathioprine, but this may not be appropriate as a blanket strategy for all patients, especially those who are stable on their current regimen. Therefore, continuing azathioprine is usually recommended to keep