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Active IBD near conception increases relapse risk during pregnancy
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Women with inflammatory bowel disease who have active disease near the time of conception have an increased risk for relapsing during pregnancy, according to prospective study data.
Investigators also found that women with ulcerative colitis were more likely to relapse during pregnancy than women with Crohn’s disease.
“The effects of active disease on birth outcomes have been reported earlier, although these outcomes do not seem representative in the era of biologicals,” researchers from Erasmus MC-University Medical Center Rotterdam in the Netherlands wrote. “Also, the retrospective nature of these studies makes it difficult to determine how these pregnant patients were treated for their disease flare.”
Therefore, the researchers prospectively studied the effect of active IBD on relapse during pregnancy and birth outcomes in a cohort of women treated as non-pregnant patients and with a contemporary spectrum of IBD treatments.
Between 2008 and 2014 they followed 229 women with IBD seen at an IBD preconception outpatient clinic. The women had 298 pregnancies and 226 live births. Researchers measured disease activity at each visit and assessed birth outcomes recorded by the patients’ obstetricians. Most patients were advised to continue IBD medication through pregnancy and 93% reported they adhered to treatment.
“Periconceptional disease activity was defined as active disease ... at any time from 8 weeks before conception until the first 2 weeks of pregnancy,” the investigators wrote.
Overall, 16.4% of patients conceived while they had active IBD, 29.7% had active disease during pregnancy, and 12.8% had a disease relapse within 3 months of delivery.
After adjusting for maternal age and smoking, the researchers observed a strong association between active disease near conception and disease relapse — both persistent activity and new flares — during pregnancy (adjusted OR = 7.66; 95% CI, 3.77-15.54).
They also found that, irrespective of disease activity near conception, age, smoking, history of surgery for IBD, immunosuppressant use or anti-TNF use, women with ulcerative colitis (n = 66) had a greater likelihood for relapsing during pregnancy than women with Crohn’s disease (n = 157; aOR = 3.71; 95% CI, 1.86-7.4).
They did not observe significant associations between IBD relapse and adverse birth outcomes, including spontaneous abortion, low birth weight or preterm birth.
All women with IBD “should be monitored closely during pregnancy, but physicians may be extra cautious in” women with ulcerative colitis, the researchers concluded. “Birth outcomes in this cohort were more reassuring than in previous studies and underline that stringent follow-up of [women with IBD] during pregnancy will benefit mother and child.” – by Adam Leitenberger
Disclosures: de Lima-Karagiannis reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
Perspective
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Marla C. Dubinsky, MD
This study underscores the importance of control of disease activity prior to conception to optimize disease control during pregnancy. Although this study did not show any association between disease relapse and adverse outcomes, inflammation can result in fetal loss and preterm delivery. Thus, counseling female IBD patients on the importance of disease control during preconception and pregnancy planning is critical.
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