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Pregnancy and Pregnancy Outcomes in Women With IBD

Pregnancy and Pregnancy Outcomes in Women With IBD. Effects of IBD on Pregnancy Outcomes. Preterm birth  risk in both UC and CD 1,2,5 4 of 5 studies: no major impact on risk of congenital abnormalities 1-5 Significant  in risk of low birth weight 2-5

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Pregnancy and Pregnancy Outcomes in Women With IBD

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  1. Pregnancy and Pregnancy Outcomes in Women With IBD

  2. Effects of IBD on Pregnancy Outcomes • Preterm birth •  risk in both UC and CD1,2,5 • 4 of 5 studies: no major impact on risk of congenital abnormalities1-5 • Significant  in risk of low birth weight2-5 •  risk of maternal/delivery complications5 1Baird DD, et al. Gastroenterology. 1990;99:987-994. 2Dominitz JA, et al. Am J Gastroenterol. 2002;97:641-648. 3Porter RJ, Stirrat GM. Br J Obstet Gynaecol. 1986;93:1124-1131. 4Fonager K, et al. Am J Gastroenterol. 1998;93:2426-2430.4Mahadevan U, et al. Gastroenterol. 2007;133:1106-1112

  3. Meta-analysis • 12 studies • N= 3907 (CD 1952, UC 1113) vs. 320, 531 • Prematurity OR = 1.87 (1.52-2.31) p<0.001 • LBW OR = 2.10 (1.38-3.19) , p<0.001 • C-section OR = 1.50 (1.26-1.79) p <0.001 • Congen Abnorm. = 2.37 (1.47-3.82) p <0.001 • 4 studies reported on the incidence IBD vs. controls, no difference • UC vs. controls in two studies (Larzilliere 1998, Dominitz) Cornish Gut 2006;0:1-8.

  4. Effect of Pregnancy on UC: Disease Activity at Conception 80 n=528 n=227 70 66 60 50 45 Percent 40 34 27 30 24 20 10 0 NoRelapse Relapse WorsenedActivity Continued Activity DecreasedActivity Inactive Active Miller JP. J R Soc Med. 1986;79:221-225.

  5. Effect of Pregnancy on CD: Disease Activity at Conception 80 73 n=186 n=93 70 60 50 Percent 40 34 33 32 27 30 20 10 0 NoRelapse Relapse WorsenedActivity Continued Activity DecreasedActivity Inactive Active Miller JP. J R Soc Med. 1986;79:221-225.

  6. Disease activity during pregnancy in women with IBD • Majority of patients have inactive to mild disease during pregnancy Disease activity in Crohn’s disease Percentage of patients Disease activity in ulcerative colitis Trimester Mahadevan U, et al. Gastroenterol. 2007;133:1106-1112

  7. Effect of Pregnancy on IBD: Maternal-Fetal HLA Disparity • Prepartum disease activity significantly predicts disease activity during pregnancy (P=.008) • In single-locus disparity, no significant difference between DR and DQ prepartum, during trimesters 1-3, or postpartum • Disparity at both DR and DQ loci significantly predicts disease activity during pregnancy (P=.001) • Maternal immune response to paternal HLA antigens may play role in pregnancy-induced remission of IBD Kane S, et al. Gastroenterology. 1998;114:A1006. Abstract G4121.

  8. Concerns Regarding Pregnancy and Delivery • What is the effect of pregnancy on pouch function before and after delivery? • Should the woman deliver vaginally or have cesarean section? • Are there unique concerns if cesarean section is performed?

  9. Delivery Mode and Perineal Injury • Study indicates that more women with IBD have cesarean sections1 • Vaginal delivery is usually safe for women with inactive perianal symptoms1 1Ilnyckyji A, et al. Am J Gastroenterol. 1999;94:3274-3278.

  10. Pouch Function During and After Pregnancy • 10 vaginal deliveries, 6 cesarean sections • No pouch complications • 8.1 bowel movements/day during pregnancy vs 6.5/day postpartum • 3 women had incontinence during pregnancy, 1 frequent and 2 mild • 1 woman had nighttime incontinencepostpartum Scott HJ, et al. Int J Colorectal Dis. 1996;11:84-87.

  11. Pregnancy, Delivery, and Pouch Function After IPAA in UC • Questionnaires sent to women with IPAA for UC • Results • 49 deliveries for 29 women (25 vaginal, 24 c-sections) • 6 pouch-related complications (2 during pregnancy; 4 postpartum) •  stool frequency and incontinence during pregnancy • 83% regained prepregnancy function; 17% had some permanent pouch function deterioration not related to delivery method • Delivery method did not affect incontinence, stool frequency • Conclusion: Pregnancy is safe for women with IPAA Ravid A, et al. Dis Colon Rectum. 2002;45:1283-1288.

  12. IBD in Pregnancy: Summary • Pregnancy outcomes best if patient in remission at time of conception, though even patients in remission can have higher rates of adverse outcomes compared to the general population • IBD increases the risk of preterm birth and low birth weight and maternal complications • No significant increase in risk of congenital abnormalities • Women with IBD have a higher rate of cesarean sections • Pregnancy may not increase the risk of relapse or significantly increase disease activit

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