Background: Even though ulcerative colitis (UC) frequently affects young women in reproductive age, it is rare to observe its first presentation during pregnancy. The aim of this study was to assess the characteristics and natural history of UC in patients who had their first presentation during pregnancy or puerperium.
Methods: We performed a retrospective unicentre case-control study, with inclusion of UC patients whose diagnosis was made during pregnancy or in the post-partum period. We used 44 women whose diagnosis was made during reproductive age but without any relationship to pregnancy as a control group (mean age at diagnosis 28±6.6 years). Demographic, clinical and treatment data was collected through access to electronical medical records. Statistical analysis was performed with SPSS® 20.0.
Results: We included as cases 9 women with a mean age at diagnosis of 28±4.7 years (range: 16.7–37.2 years). Concerning extension according to Montreal classification, 1 patient (11.1%) had proctitis, 2 patients (22.2%) distal colitis and 6 patients (66.7%) extensive colitis. Three cases occurred in former smokers but in only 2 the cessation of smoking occurred in the months previous to diagnosis.
There was a statistically significant difference regarding smoking status between cases and controls (smokers/former smokers: 50% in cases vs 11.9% in controls; p=0.05). Even though the differences weren't statistically significant, we observed a greater proportion of extensive colitis in cases comparatively to controls [66.7% vs 36.4%, p=non-significant (NS)]. Cases also had a greater need of corticosteroids at diagnosis, even after adjustment for confounding variables (OR 6.3; IC95% 1.1–35.9; p=0.04), which may indicate a greater severity of the disease at presentation. However, we found no differences between cases and controls in the need of corticosteroids (77.8% vs 50%, p=NS), immunomodulators (11.1% vs 15.9%, p=NS) or biologic treatment (22.2% vs 11.4%, p=NS) during follow up.
Conclusions: Smoking status, namely smoking cessation, appears to have a relationship with the risk of presentation of UC during pregnancy or puerperium, which is in agreement with the known relationship of tobacco and UC described in the literature. Even though the presentation of the disease in this period appears to be more severe, this doesn't seem to affect its natural history, as represented by the need of a more aggressive treatment.