Predictors of disease activity during pregnancy in women with inflammatory bowel disease—a Danish cohort study. Issue 3 (14th December 2022)

• Record Type: Journal Article
• Authors: Vestergaard, Thea; Julsgaard, Mette; Røsok, Julie F.; Vestergaard, Søren V.; Helmig, Rikke B.; Friedman, Sonia; Kelsen, Jens
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 57:Issue 3(2023)
• Page Start: 335
• Page End: 344
• Publication Date: 2022-12-14
• Subjects: disease activity -- IBD -- pregnancy -- risk factors; Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.17348
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background and Aims: Inflammatory bowel disease (IBD) activity during pregnancy is associated with adverse pregnancy outcomes. We aimed to identify key clinical characteristics that predict disease activity during pregnancy. Methods: Between January 2008 through 2021, we identified all singleton pregnancies among women with IBD recorded in patient and birth registries at a tertiary IBD centre in Denmark. Maternal and infant data were retrieved from medical records. Demographics, Physicians Global Assessment (PGA) of disease activity 6 months prior to pregnancy and in all three trimesters of pregnancy and pregnancy outcomes were recorded. Results: In 609 pregnancies, we observed 603 (99.0%) live births. Disease activity in one or more trimesters was seen in 283 women (46.5%). UC phenotype was associated with an increase in risk of disease activity (adjusted OR = 2.6 [1.8–3.9]; p < 0.001). Disease activity within 6 months prior to conceiving (169 women [27.7%]) was associated with an increased risk of continuous disease activity during pregnancy (adjusted OR of 5.3 [3.5–8.2]; p < 0.001). Disease activity during a previous pregnancy was associated with an increased risk of flares in subsequent pregnancies (adjusted OR of 3.2 [1.5–6.6]; p = 0.002). Sustained clinical remission throughout pregnancy was associated with an increased probability of normal birth term, birthweight and low risk of fetal growth restriction (FGR) and stillbirth. Conclusion: Predictors for disease activity include disease activity in a previous pregnancy and/or prior to conception, as well as UC phenotype. Reassuringly, women with IBD in remission are not at increased risk of adverse pregnancy outcomes. Abstract : Odds ratio of alternating disease courses in subsequent pregnancies, UC and CD combined. Odds ratio of experiencing disease activity during pregnancy depending on occurrence of disease activity within 6 months of conception and attainment of remission at time of conception. Odds ratio of experiencing disease activity during pregnancy depending on IBD subtype.