Higher rates of preterm delivery, low birthweight observed with IBD in twin pregnancies
Key takeaways:
- The IBD cohort had higher rates of preterm delivery and infants with low birthweight compared with the healthy control cohort.
- These findings were consistent even among women with well-controlled IBD.
Women with inflammatory bowel disease who delivered a twin gestation pregnancy had higher rates of preterm delivery and infants born small for gestational age or with low birthweight compared with healthy controls, according to research.
“This idea [for the study] came to me a few years ago when I realized that all of our pregnancy literature is based on singleton pregnancies, and we had no idea what was happening in multiple gestations,” Sunanda V. Kane, MD, MSPH, study author and professor of medicine in the division of gastroenterology and hepatology at Mayo Clinic, told Healio. “Now with the increase in assisted reproductive technologies, the chance of a multiple gestation is higher.”
In a multicenter, retrospective study, Kane and colleagues investigated maternal and fetal outcomes of twin gestation pregnancies among women with IBD compared with healthy controls.
The IBD cohort included 35 women aged 18 to 40 years (mean age, 31 years), of whom 22 had a history of Crohn’s disease, 12 had ulcerative colitis and one had indeterminate colitis; 31.4% were aged 35 years or older. Biologics, including tumor necrosis factor-alpha (n = 17) or interleukin inhibitor (n = 2) therapies, were continued throughout the pregnancies.
The historic control cohort included 10,352 twin pregnancies in women (mean maternal age, 32.3 years) residing in Massachusetts from 2004 to 2010, 36.9% of whom were aged 35 years or older. More than one-third (34.2%) of the control pregnancies were conceived via in vitro fertilization.
According to results published in Clinical Gastroenterology and Hepatology, preterm delivery rates were higher in the IBD cohort compared with controls (78.8% vs. 53.4%), as were rates of infants born small for gestational age (59.1% vs. 18.7%). Mean birthweight also was lower in the IBD cohort (2,168 g vs. 2,408 g), which had a larger proportion of infants born with low birthweight (< 2,500 g; 81.8% vs. 51.7%).
These rates remained higher in the IBD cohort when pregnancies with advanced maternal age and those conceived via in vitro fertilization were removed from analysis, the researchers noted.
“A multiple gestation pregnancy carries its own risks and it is not different for a patient with inflammatory bowel disease,” Kane said. “[Pregnant women with IBD] need to be followed by high-risk OB, as well as an IBD expert, and continue taking her meds to control disease.”
The researchers also reported three spontaneous abortions in the IBD cohort, which included two losses of both twins at weeks 10 and 20 and the loss of one triplet at week 7, followed by the delivery of the remaining two at week 28.
“This is the first paper looking at multiple gestations, so it is novel in its scope,” Kane told Healio. “In the future we should be following multiple gestation pregnancies in a separate registry prospectively to follow their outcomes, just as we are doing in the PIANO registry.”
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