Erickson and Propert from the University of Kentucky and the University of Pennsylvania recently wrote a thoughtful review of pregnancy and BPS/IC that many clinicians will find helpful.

How might pregnancy effect symptoms of BPS/IC? Both estrogen and progesterone have been reported to stimulate growth of cultured urothelial cells. They also influence growth factors such as nerve growth factor, epidermal growth factor, and heparin-binding epidermal growth factor-like growth factor. As all 3 of these factors have been shown to be altered in the urine or bladder of BPS/IC patients, one can postulate that hormonal changes associated with pregnancy may influence symptoms by modulating the effects of these growth factors. Another avenue by which pregnancy may play a role in symptoms is through the augmentation of mast cell activation by estrogen. In general, estrogen enhances inflammation and androgens and progesterone are suppressors. Gonadal hormones have many effects on the central and peripheral nervous systems, and it is thought that pregnancy is associated with increased pain threshold.

Two conflicting retrospective studies of BPS/IC and pregnancy suggest that pregnancy in patients with severe symptoms can be palliative (Interstitial Cystitis Association patient survey), or that pregnancy does not improve symptoms in the vast majority of IC patients (Interstitial Cystitis Database Study).

Erickson and Propert look at commonly used treatments and suggest that while pentosanpolysulfate has not been studied in pregnant patients, it is likely to be safe. Amitriptyline seems to have a low risk as well. Hydroxyzine should be avoided as it has been shown to increase the relative risk of malformations in pregnancy and can result in withdrawal symptoms in newborns. There is no published data on DMSO in pregnancy and it should be avoided. Intravesical heparin is probably safe except for the risk of urinary infection from catheterization. Intravesical non-alkalinized lidocane is minimally absorbed from the bladder, but its efficacy is poor because it does not penetrate the epithelium. Sacral nerve stimulators should not be placed during pregnancy, and if in place, should be turned off.

The knowledge that the baseline risk for fetal malformations in pregnancy is 2%-4% should make one wary treating IC during pregnancy other than by conservative, non-medical techniques. Any treatment should be cleared by the obstetrician, and watchful waiting and hoping the natural history during gestation is one of improvement is not an unreasonable tact to take.

Erickson DR, Propert KJ

Urol Clin N Am 34:61-69, 2007

UroToday.com Painful Bladder Syndrome Section

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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