DOP80 Prevalence and factors associated with Inflammatory Bowel Disease (IBD) activity during pregnancy: updated data from the DUMBO Registry
Authors: Chaparro M , García Donday M , Núñez Ortiz A , Calviño Suarez C , Rubio Iturria S , Sánchez Azofra M , Calvo Moya M , Pérez-Martínez I , Fernández-Clotet A , Alfambra E , Marín Pedrosa S , Diz-Lois Palomares M T , Hernandez V , Ruiz-Cerulla A , Casanova M J , Rivero M , Huguet J M , Vicente Lidón R , Árias García L , Guerra I , Hervías Cruz D , Gutiérrez Casbas A , Bejarano A , Camargo Camero R , Rodríguez-Lago I , Aguas M , De Jorge Turrión M Á , Masedo Gonzalez Á , López Serrano P , Valldosera Gomis G , Ceballos D , Bujanda L , Molina Arriero G , Vega Villaamil P , Van Domselaar M , Boscá Watts M M , Lucendo A J , Zúñiga de Mora-Figueroa B , Busquets D , Gisbert J P 
Published: January 2024

Abstract

Background
IBD remission is key for pregnancy outcomes. Previous studies have suggested a disease recurrence risk of approximately 30% in patients in remission at conception, but this could be influenced by disease control in the periconceptional period and the discontinuation of treatments for IBD during pregnancy.

Aim
To provide updated data on the incidence of disease relapse during pregnancy in IBD patients and to identify predictive factors of relapse.

Methods
Pregnant patients with IBD from DUMBO registry were included. DUMBO is a prospective, observational, and multicentre registry, endorsed by GETECCU which enrols pregnant women with IBD over 5 years in 70 centres in Spain. Study protocol is summarized in figure 1a. Relapse was defined based on the Crohn’s Disease Activity Index and the Partial Mayo Score in Crohn’s disease (CD) and ulcerative colitis (UC), respectively. Only patients in clinical remission at conception were considered for the relapse risk analysis (Cox-regression analysis). Only serious adverse events (SAE) were recorded.

Results
1,033 patients were available in DUMBO registry, 57 (5.5%) had active disease at conception. 830 patients had given birth (98% singleton), 69 had early termination (48 of them miscarriages), and 134 pregnancies were still ongoing. The probability of having active disease at each trimester was higher in patients with active disease at conception (table 1a). Seven patients underwent surgery due to IBD during pregnancy (3 abdominal and 4 perianal surgery); all of them were in remission at conception. The proportion of patients with severe infections during pregnancy was higher in patients with active disease during pregnancy (2.8% vs. 0.8%, p&lt;0.05); there were no differences in other SAE based on the activity. 73 out of 976 patients in remission at conception relapsed throughout pregnancy or puerperium (figure 1b, table 1b). The proportion of patients who withdrew treatment during pregnancy, excepting mesalamine, was similar between relapsers and non-relapsers (table 1c). To have UC vs. CD (Hazard ratio=3, 95% confidence interval=1.8-5.3) was the only variable associated with the risk of relapse.

Conclusion
The risk of having active disease during pregnancy was higher in patients with activity at conception. The risk of relapse in patients in remission at conception was lower than previously described. The risk of relapse was 3-fold higher in UC than in CD. Since most relapses occur from the second trimester of gestation onwards, and serious complications (including surgery) can occur also in patients in remission at conception, monitoring IBD during this period should be closely conducted.