Background: Inflammatory bowel disease (IBD) is a chronic relapsing and remitting immune disorder with morbidities that impair function and quality of life. The disease has an increasing prevalence, and is frequently diagnosed at childbearing age. Given that IBD requires life-long medication, it is important to monitor and manage disease activity for successful pregnancy outcomes. We were interested to better understand the effect of IBD on pregnancy outcomes.
Methods: Between 2011 and 2015, a total of 39 pregnant patients with IBD were reviewed. Sixteen had Crohn's disease (CD) and 23 had ulcerative colitis (UC). We retrospectively evaluated the 41 pregnancy outcomes in these 39 patients. In the CD cases, active disease was defined as CD activity index (CDAI) ≥150), while in the UC cases, active disease was defined as clinical activity index (CAI) ≥4. The pregnancy and neonatal complications including spontaneous abortion, preterm delivery (<37 weeks), caesarean section, low birth weight (<2500g) and congenital abnormality were determined.
Results: The mean age was 33.5±4.2 years in CD patients and 32.7±5.2 years in UC patients. For most patients, IBD was inactive prior to pregnancy (84%, n=33). Elemental diet (n=9 cases) and anti-tumour necrosis factor-α biologics (n=10) were the most commons drugs used during pregnancy in CD patients, while mesalamine (n=22) was the most common drug in UC patients. Flare up rate during pregnancy was higher in UC patients than in CD (62.5% vs 29.4%). Most patients relapsed in the first pregnancy trimester (28.5%) and puerperal period (60%). The rate of preterm delivery (12.2%), low birth weight (22.0%) and caesarean section (31.7%) were not significantly different from non-IBD controls (n=394; 28.4%, 32.3%, 46.4% respectively). However, the rate of congenital abnormality was higher in IBD patients than in non-IBD (7.3% vs 0.2%). The rate of neonatal and pregnancy complications was significantly higher during active disease than during quiescent period (p<0.05).
Conclusions: We found that IBD flare ups had occurred particularly in the first pregnancy trimester and puerperal period. Flare up rate was higher in UC patients than in CD patients. Accordingly, IBD patients, particularly UC patients should be diligently monitored in the first pregnancy trimester and puerperal period. Likewise, in this study the prevalence of congenital abnormality was higher in IBD patients than in non-IBD, but we did not investigate the risk factors for congenital abnormality in the IBD clinical setting.