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Endoscopy appears safe during pregnancy
Adverse pregnancy outcomes are rare in women who undergo endoscopy during pregnancy, according to the results of a Swedish population-based cohort study.
While endoscopy during pregnancy was associated with higher risks for preterm birth and small size for gestational age, these risks were small and probably due to factors unrelated to the procedure, investigators concluded. Moreover, endoscopy during pregnancy was not associated with congenital malformation or stillbirth.
“In this population-based study, we compared pregnancy outcomes in 3,000 pregnancies exposed to endoscopy with about 1.6 million pregnancies without endoscopy exposure,” Jonas F. Ludvigsson, MD, of the department of medical epidemiology and biostatistics at Karolinska Institutet, Stockholm, Sweden, and colleagues wrote. “While endoscopy was linked to adverse pregnancy outcome, we suggest that most if not all of the excess risks are due to disease activity. Also, women having an endoscopy outside pregnancy were at increased risk of adverse pregnancy outcomes.”
Jonas F. Ludvigsson
Using national registry data spanning 1992 through 2011, Ludvigsson and colleagues identified 3,052 pregnancies during which the patient underwent upper endoscopy (n = 2,025), lower endoscopy (n = 1,109), or endoscopic retrograde cholangiopancreatography (n = 58), and compared the risk for adverse pregnancy outcome with that of 1,589,173 pregnancies during which no endoscopic procedure occurred. They also compared outcomes in women who underwent endoscopy just before or after pregnancy to account for disease activity, and compared pregnancies within the same mother to account for intrafamiliar factors.
They found that undergoing endoscopy during pregnancy was associated with a higher risk for preterm birth (adjusted RR = 1.54; 95% CI, 1.36-1.75) and small for gestational age (aRR = 1.3; 95% CI, 1.07-1.57), but was not associated with higher risks for congenital malformation or stillbirth. These associations were independent of trimester.
While 15 stillbirths occurred among women who underwent endoscopy, none occurred within the 2 weeks following the procedure.
When comparing women who underwent endoscopy less than a year before or after pregnancy with women who underwent endoscopy during pregnancy, the investigators found that endoscopy during pregnancy was associated with preterm birth (aRR = 1.16), but not with small for gestational age, stillbirth or congenital malformation.
When comparing only women without inflammatory bowel disease, celiac disease or liver disease who underwent endoscopy during pregnancy or shortly before or after, they found that endoscopy during pregnancy was not associated with preterm birth.
Finally, when comparing births within the same mother, who underwent endoscopy during only one pregnancy, the investigators found endoscopy was not associated with gestational age or birth weight.
“Earlier recommendations suggest that endoscopy should only be performed during pregnancy if there are strong indications and, if so, not during the second trimester,” Ludvigsson and colleagues wrote. “Our study shows that endoscopy is unlikely to have a more than marginal influence on pregnancy outcome independently of trimester.
“Potential excess risks, if any, seem minimal and should be weighed against the need for timely investigation and treatment of women where an underlying GI disease may be a more severe threat to pregnancy outcome than the endoscopy,” they concluded.
Despite certain limitations, this large national registry study “provides robust power to investigate the statistical significance of uncommon, but important, pregnancy complications,” and should inform evidence-based guidelines, according to a related editorial authored by Mitchell S. Cappell, MD, of the division of gastroenterology and hepatology at William Beaumont Hospital, and the department of medicine at Oakland University, William Beaumont School of Medicine, Royal Oak, Michigan. “These newly published data should prompt a new systematic review of this subject to promulgate new, revised guidelines on endoscopy indications during pregnancy,” he concluded. – by Adam Leitenberger
Disclosures: The researchers and Cappell report no relevant financial disclosures.