Pregnancy and Pregnancy Outcomes in Women With IBD

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.
199099987-994. 2Dominitz JA, et al. Am J
Gastroenterol. 200297641-648. 3Porter RJ,
Stirrat GM. Br J Obstet Gynaecol.
1986931124-1131. 4Fonager K, et al. Am J
Gastroenterol. 1998932426-2430.4Mahadevan U, et
al. Gastroenterol. 20071331106-1112
3
Meta-analysis

• 12 studies
• N 3907 (CD 1952, UC 1113) vs. 320, 531
• Prematurity OR 1.87 (1.52-2.31) plt0.001
• LBW OR 2.10 (1.38-3.19) , plt0.001
• C-section OR 1.50 (1.26-1.79) p lt0.001
• Congen Abnorm. 2.37 (1.47-3.82) p lt0.001
• 4 studies reported on the incidence IBD vs.
  controls, no difference
• UC vs. controls in two studies (Larzilliere
  1998, Dominitz)

Cornish Gut 200601-8.
4
Effect of Pregnancy on UC Disease Activity at
Conception
80
n528
n227
66
70
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. 198679221-225.
5
Effect of Pregnancy on CD Disease Activity at
Conception
80
73
n186
n93
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. 198679221-225.
6
Disease activity during pregnancy in women with
IBD

• Majority of patients have inactive to mild
  disease during pregnancy

Disease activity in Crohns disease
Percentage of patients
Disease activity in ulcerative colitis
Trimester
Mahadevan U, et al. Gastroenterol.
20071331106-1112
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. 1998114A1006.
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.
1999943274-3278.
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.
19961184-87.
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.
2002451283-1288.
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