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Pregnancy and Pregnancy Outcomes in Women With IBD. Effects of IBD on Pregnancy Outcomes. Preterm birth risk in both UC and CD 1,2,5 4 of 5 studies: no major impact on risk of congenital abnormalities 1-5 Significant in risk of low birth weight 2-5 - PowerPoint PPT Presentation
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Pregnancy and Pregnancy and Pregnancy Outcomes Pregnancy Outcomes
in Women With IBDin Women With IBD
Effects of IBD on Effects of IBD on Pregnancy OutcomesPregnancy Outcomes
Preterm birth Preterm birth risk in both UC and CDrisk in both UC and CD1,2,51,2,5
4 of 5 studies: no major impact on risk of congenital 4 of 5 studies: no major impact on risk of congenital abnormalitiesabnormalities1-51-5
Significant Significant in risk of low birth weight in risk of low birth weight2-52-5
risk of maternal/delivery complicationsrisk of maternal/delivery complications55
11Baird DD, et al. Baird DD, et al. Gastroenterology.Gastroenterology. 1990;99:987-994. 1990;99:987-994. 22Dominitz JA, et al. Dominitz JA, et al. Am J Gastroenterol.Am J Gastroenterol. 2002;97:641- 2002;97:641-648. 648. 33Porter RJ, Stirrat GM. Porter RJ, Stirrat GM. Br J Obstet Gynaecol.Br J Obstet Gynaecol. 1986;93:1124-1131. 1986;93:1124-1131. 44Fonager K, et al. Fonager K, et al. Am J Gastroenterol.Am J Gastroenterol. 1998;93:2426-2430.1998;93:2426-2430.44Mahadevan U, et al. Gastroenterol. 2007;133:1106-1112
Meta-analysisMeta-analysis
12 studies12 studies– N= 3907 (CD 1952, UC 1113) vs. 320, 531N= 3907 (CD 1952, UC 1113) vs. 320, 531
Prematurity OR = 1.87 (1.52-2.31) Prematurity OR = 1.87 (1.52-2.31) p<0.001p<0.001
LBW OR = 2.10 (1.38-3.19) , LBW OR = 2.10 (1.38-3.19) , p<0.001p<0.001
C-section OR = 1.50 (1.26-1.79) C-section OR = 1.50 (1.26-1.79) p <0.001p <0.001
Congen Abnorm. = 2.37 (1.47-3.82) Congen Abnorm. = 2.37 (1.47-3.82) p <0.001p <0.001– 4 studies reported on the incidence IBD vs. controls, no 4 studies reported on the incidence IBD vs. controls, no
differencedifference– UC vs. controls in two studies (Larzilliere 1998, Dominitz)UC vs. controls in two studies (Larzilliere 1998, Dominitz)
Cornish Gut 2006;0:1-8. Cornish Gut 2006;0:1-8.
Effect of Pregnancy on UC: Effect of Pregnancy on UC: Disease Activity at ConceptionDisease Activity at Conception
Miller JP. Miller JP. J R Soc Med.J R Soc Med. 1986;79:221-225. 1986;79:221-225.
InactiveInactive ActiveActive
NoNoRelapseRelapse
RelapseRelapse WorsenedWorsenedActivityActivity
ContinuedContinuedActivityActivity
DecreasedDecreasedActivityActivity
00
n=528n=528 n=227n=2276666
3434
4545
2424 2727
8080
7070
6060
5050
4040
3030
2020
1010
Perc
en
tP
erc
en
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3232
Effect of Pregnancy on CD: Effect of Pregnancy on CD: Disease Activity at ConceptionDisease Activity at Conception
Miller JP. Miller JP. J R Soc Med.J R Soc Med. 1986;79:221-225. 1986;79:221-225.
InactiveInactive ActiveActive
NoNoRelapseRelapse
RelapseRelapse WorsenedWorsenedActivityActivity
ContinuedContinuedActivityActivity
DecreasedDecreasedActivityActivity
00
n=186n=186 n=93n=937373
27273333 3434
8080
7070
6060
5050
4040
3030
2020
1010
Perc
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Disease activity during pregnancy in women Disease activity during pregnancy in women with IBDwith IBD
Majority of patients have inactive to mild disease during Majority of patients have inactive to mild disease during pregnancypregnancy
Mahadevan U, et al.Mahadevan U, et al. Gastroenterol. Gastroenterol. 2007;133:1106-1112 2007;133:1106-1112
020406080
100
020406080
100
Concept T1 T2 T3 PP
Inactive
Mild
Moderate
Severe
Trimester
Per
cen
tag
e o
f p
atie
nts
Disease activity in Crohn’s disease
Disease activity in ulcerative colitis
Effect of Pregnancy on IBD: Effect of Pregnancy on IBD: Maternal-Fetal HLA DisparityMaternal-Fetal HLA Disparity
Prepartum disease activity significantly predicts Prepartum disease activity significantly predicts disease activity during pregnancy (disease activity during pregnancy (PP=.008)=.008)
In single-locus disparity, no significant difference In single-locus disparity, no significant difference between DR and DQ prepartum, during trimesters 1-3, between DR and DQ prepartum, during trimesters 1-3, or postpartumor postpartum
Disparity at both DR and DQ loci significantly predicts Disparity at both DR and DQ loci significantly predicts disease activity during pregnancy (disease activity during pregnancy (PP=.001)=.001)
Maternal immune response to paternal HLA antigens Maternal immune response to paternal HLA antigens may play role in pregnancy-induced remission of IBDmay play role in pregnancy-induced remission of IBD
Kane S, et al. Kane S, et al. Gastroenterology.Gastroenterology. 1998;114:A1006. Abstract G4121. 1998;114:A1006. Abstract G4121.
Concerns Regarding Concerns Regarding Pregnancy and DeliveryPregnancy and Delivery
What is the effect of pregnancy on pouch What is the effect of pregnancy on pouch function before and after delivery?function before and after delivery?
Should the woman deliver vaginally or have Should the woman deliver vaginally or have cesarean section?cesarean section?
Are there unique concerns if cesarean section Are there unique concerns if cesarean section is performed?is performed?
Delivery Mode and Delivery Mode and Perineal InjuryPerineal Injury
Study indicates that more women with IBD have Study indicates that more women with IBD have cesarean sectionscesarean sections11
Vaginal delivery is usually safe for women with inactive Vaginal delivery is usually safe for women with inactive perianal symptomsperianal symptoms11
11Ilnyckyji A, et al. Ilnyckyji A, et al. Am J Gastroenterol.Am J Gastroenterol. 1999;94:3274-3278. 1999;94:3274-3278.
Pouch Function During and After Pouch Function During and After PregnancyPregnancy
10 vaginal deliveries, 6 cesarean sections10 vaginal deliveries, 6 cesarean sections– No pouch complicationsNo pouch complications
8.1 bowel movements/day during pregnancy 8.1 bowel movements/day during pregnancy vs 6.5/day postpartumvs 6.5/day postpartum
3 women had incontinence during pregnancy, 3 women had incontinence during pregnancy, 1 frequent and 2 mild1 frequent and 2 mild
1 woman had nighttime incontinence1 woman had nighttime incontinencepostpartumpostpartum
Scott HJ, et al. Scott HJ, et al. Int J Colorectal Dis.Int J Colorectal Dis. 1996;11:84-87. 1996;11:84-87.
Pregnancy, Delivery, Pregnancy, Delivery, and Pouch Function and Pouch Function
After IPAA in UCAfter IPAA in UC Questionnaires sent to women with IPAA for UCQuestionnaires sent to women with IPAA for UC
ResultsResults
– 49 deliveries for 29 women (25 vaginal, 24 c-sections)49 deliveries for 29 women (25 vaginal, 24 c-sections)
– 6 pouch-related complications (2 during pregnancy; 6 pouch-related complications (2 during pregnancy; 4 postpartum)4 postpartum)
stool frequency and incontinence during pregnancystool frequency and incontinence during pregnancy
– 83% regained prepregnancy function; 17% had some 83% regained prepregnancy function; 17% had some permanent pouch function deterioration not related to permanent pouch function deterioration not related to delivery methoddelivery method
– Delivery method did not affect incontinence, Delivery method did not affect incontinence, stool frequencystool frequency
Conclusion: Pregnancy is safe for women with IPAAConclusion: Pregnancy is safe for women with IPAA
Ravid A, et al. Ravid A, et al. Dis Colon Rectum.Dis Colon Rectum. 2002;45:1283-1288. 2002;45:1283-1288.
IBD in Pregnancy: IBD in Pregnancy: SummarySummary
Pregnancy outcomes best if patient in remission at time of Pregnancy outcomes best if patient in remission at time of conception, though even patients in remission can have conception, though even patients in remission can have higher rates of adverse outcomes compared to the general higher rates of adverse outcomes compared to the general populationpopulation
IBD increases the risk of preterm birth and low birth weight IBD increases the risk of preterm birth and low birth weight and maternal complicationsand maternal complications
No significant increase in risk of congenital abnormalitiesNo significant increase in risk of congenital abnormalities
Women with IBD have a higher rate of cesarean sectionsWomen with IBD have a higher rate of cesarean sections
Pregnancy may not increase the risk of relapse or Pregnancy may not increase the risk of relapse or significantly increase disease activitsignificantly increase disease activit