Risk of active IBD during pregnancy
Risk of active IBD during pregnancy
February 7, 2023
Issue 03
Clinical Question
Can we predict which women have the greatest risk of IBD disease activity during pregnancy?
Editor’s Bottom Line
IBD activity with previous pregnancies and prior to conception predicts activity in pregnancy. The best time to conceive may be in stable remission.
Reference
Vestergaard T, Julsgaard M, Røsok JF, et al. Predictors of disease activity during pregnancy in women with inflammatory bowel disease-a Danish cohort study. Aliment Pharmacol Ther. Epub ahead of print Dec 14, 2022; https://onlinelibrary.wiley.com
Synopsis
As disease activity in IBD patients during pregnancy increases the risk of adverse pregnancy outcomes, Danish and American researchers set out to identify predictors of active illness during gestation. To that end, they retrospectively analyzed data from 378 women with IBD, including a total of 352 singleton pregnancies in women with ulcerative colitis (UC) and 257 in women with Crohn’s disease (CD) between 2008 and 2021.
Overall, they found a 1% stillbirth rate, an 8.8% prevalence of infants who were small for their gestational age, a 5.5% rate of low birth weight and a preterm birth rate of 8%. Additionally, 0.3% of newborns had an Apgar score <7 at five minutes after birth and 8.5% had malformations, roughly half of which were serious.
Over 46% of women had disease activity during one or more trimesters, and those with UC were more likely than those with CD to experience active disease (adjusted Odds Ratio [aOR]: 2.6; 95% Confidence Interval [CI], 1.8–3.9; p<0.001).
Analyses of patient and clinical characteristics found that women with active disease during the six months prior to conception had a higher risk of experiencing ongoing disease activity during pregnancy, compared to those with inactive disease during the prior six months (aOR: 5.3; 95% CI, 3.5–8.2; p<0.001). Additionally, the risk of disease activity during pregnancy was higher among those with a history of IBD activity during prior pregnancies (aOR: 3.2; 95% CI, 1.5–6.6; p=0.002).
Other results demonstrated the benefits of maintaining remission during pregnancy, showing that women with sustained clinical remission throughout their pregnancy were more likely to birth a healthy birthweight child during the normal birth term period and less likely to have a fetus with growth restriction and also less likely to experience a stillbirth.
Details
Study Design: Retrospective cohort
Funding: Aarhus University, the Colitis-Crohn Organization Denmark, the Danish Rheumatism Association and the A.P. Moeller Foundation of the Advancement of Medical Science
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b