ColestiraminaLa colestiramina puede utilizarse libremente en el embarazo,sobre todo en pacientes con diarrea secundariaa ileítis termin<strong>al</strong> o resección ile<strong>al</strong> (54) .LactanciaLas ventajas de la lactancia materna son ampliamenteconocidas, siendo una de ellas el menor riesgo que ellactante tiene de desarrollar <strong>EII</strong> posteriormente (88) . Detodas formas, la lactancia es una preocupación primordi<strong>al</strong>en las pacientes que temen por la seguridad de suslactantes.En un estudio llevado a cabo durante el postparto seencontró que solamente el 44% de madres con <strong>EII</strong> optabanpor la lactancia materna y que esta decisión estabainfluenciada por factores que iban desde la recomendaciónmédica y el miedo a interacciones farmacológicas,hasta la decisión person<strong>al</strong> (52) . En nuestro medio,un estudio reciente corroboró que la lactancia maternaera significativamente menos frecuente en los hijos nacidosdespués del diagnóstico de <strong>EII</strong> en comparación conlos nacidos antes del diagnóstico (33) . Sin embargo, existentratamientos que pueden ser utilizados con seguridad,como son la sulfas<strong>al</strong>azina, la mes<strong>al</strong>azina y los esteroidestópicos y or<strong>al</strong>es. Del resto de fármacos o se disponede poca información o están contraindicados porsu riesgo potenci<strong>al</strong>, como son metotrexate, ciclosporina,micofenolato de mofetilo, tacrolimus, ciprofloxacinoo metronidazol. Existe un grupo de fármacos cuyautilización debe ser individu<strong>al</strong>izada según los requerimientosmaternos por su potenci<strong>al</strong> toxicidad, a pesar deque la información sobre sus efectos en los lactantes esmínima; entre ellos se encuentran azatioprina, 6-mercaptopurinay los anti-TNF (89) .ConclusionesLa posibilidad de una gestación s<strong>al</strong>udable es una preocupaciónprimordi<strong>al</strong> en el curso evolutivo de los pacientesjóvenes con <strong>EII</strong>. Por tanto, es importante transmitir a lospacientes que tanto la fertilidad como la morbimort<strong>al</strong>idadmaterno-fet<strong>al</strong> de las gestaciones no suelen estar aumentadasrespecto a la población gener<strong>al</strong>, y que sólo lasconcepciones durante periodos de actividad de la <strong>EII</strong>, elantecedente de cirugía pélvica (proctectomía, reservorioíleo-an<strong>al</strong>) y determinados fármacos, pueden cambiarlo.El embarazo es un momento idóneo para reforzar elabandono del tabaquismo.Por último, debería fomentarse la lactancia materna enpacientes con <strong>EII</strong> puesto que podría reducir la incidenciade <strong>EII</strong> en los hijos; para ello es cruci<strong>al</strong> disponer deuna mayor información acerca del paso de ciertos fármacoscomo las tiopurinas o los agentes biológicos a l<strong>al</strong>eche materna y su potenci<strong>al</strong> efecto <strong>al</strong> ser ingeridos porlos recién nacidos.BIBLIOGRAFÍA1. 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