P0265 A retrospective cohort study of pregnant women with Inflammatory Bowel Disease – outcomes from a multidisciplinary clinic in a tertiary centre
Authors: Yeo J H , Mackenzie H , Lambo D , Parker H , McCartney S , Williams D , Harrow P 
Published: January 2025

Background

Inflammatory bowel disease (IBD) has an impact on pregnancy outcomes due to disease activity and medication use. We conducted a retrospective cohort study to evaluate pregnancy outcomes at a large tertiary IBD centre in the UK.

Methods

Pregnant IBD patients at our unit are managed by a multidisciplinary team with joint obstetric medicine and gastroenterology review. Consecutive patients from January 2023 to December 2023 were included. Data was extracted from EPIC electronic health record. Multiple logistic regression analysis was performed using Prism version 10.4

Results

90 unique women were included in the study. 55 (61.1%) had Crohn’s disease (CD), 32 (35.6%) had ulcerative colitis (UC) and 3 (3.3%) had IBD-U. 9 (10%) had either prior or active perianal disease. Median disease duration was 8 years and the median age at conception was 35 years. Median preconception BMI was 23.1kg/m2. At conception, 37 (41.1%) were on biologics, 9 (10.0%) were on thiopurines, 25 (27.8%) were on mesalazine, 4 (4.4%) were on oral steroids and 22 (24.4%) were not on any treatment.

A flare was defined as a faecal calprotectin of ≥250ug/g or exacerbation of symptoms (SCCAI &gt;2 or HBI &gt;4). 43 (47.8%) experienced a flare during pregnancy. Flares were treated with mesalazine (n = 20, 22.2%) and/or systemic corticosteroids (n=12, 13.3%) with 5 (5.6%) patients initiated on biologic therapy during pregnancy. Biologics were stopped in the third trimester in only 6 (16.2%) patients.

86 (96%) patients had a live singleton birth. There were 3 (3.3%) miscarriages and 1 (1.1%) termination of pregnancy due to fetal anomalies. The majority of women had a vaginal delivery (n=36, 41.8%) or an elective caesarean section (n=31, 36.0%). There were 3 (3.4%) preterm births and the median gestational age at birth was 39 weeks. The median birth weight was 3282g. There were 5 (5.8%) neonates with a low birth weight and 5 (5.8%) had fetal macrosomia.

Maternal infections occurred in 5 (5.6%) with the majority being intrapartum sepsis (n=3). One neonate was admitted to neonatal intensive care due to complications from an emergency vaginal breech delivery.

Gestational diabetes (GDM) occurred in 20 women (22.2%) which was higher than the European prevalence of 5%. [1] Based on multivariable logistic regression analysis, the higher rates of GDM was independent of steroid exposure, baseline BMI and active disease in pregnancy.

Conclusion

IBD flares were common in our cohort which reflects the complexity of patients referred to our service. Obstetric and neonatal outcomes were similar to the general population. We observed a higher rate of GDM which was independent of steroid exposure, BMI and disease activity.

References

1.Eades CE, Cameron DM, Evans JMM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. Diabetes Res Clin Pract. 2017 Jul;129:173-181. doi: 10.1016/j.diabres.2017.03.030. Epub 2017 May 9. PMID: 28531829.