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P192. Modification of the course of inflammatory bowel disease (IBD) during pregnancy and after delivery

A. Alcalde Vargas1, C. Trigo Salado1, E. Leo Carnerero1, M.D. De la Cruz Ramírez1, J.M. Herrera Justiniano1, 1Virgen del Rocío Hospital, Gastroenterology, Sevilla, Spain

Background

Pregnancy is a common event during follow-up that can interfere with the course of the disease. Objectives: To assess the course of the disease during pregnancy and after delivery. Modification of the course of IBD was defined as the need for corticosteroids, immunosuppressors (IS), biological agents or surgery due to disease activity or complications. To establish predictors of disease modification. To assess the incidence of miscarriage, malformations and perinatal morbimortality.

Methods

A retrospective study was made of women with IBD and pregnancy during the period 2007–2011.

Results

99 patients, 39 with ulcerative colitis (UC) and 60 with Crohn's disease (CD).

Modification of IBD during pregnancy occurred in 19.2% and was more frequent in UC (30.8%) than in CD (11.7%). During postpartum, disease modification was observed in 37.4% of the patients, with similar rates for UC (38.5%) and CD (36.7%).

The univariate analysis showed a greater risk of reactivation during pregnancy in patients with UC (p = 0.01; OR: 3.4), independently of disease extent or activity at the start of pregnancy, and in patients with CD and prior surgery (p = 0.01, OR: 1.3). Presence of a disease flare-up during pregnancy proved to be a risk factor for UC (p = 0.01; OR: 5.7). No associated factors were identified in CD.

No significant differences were observed between patients who discontinued and those who continued treatment with IS and/or biological drugs in terms of the course of the disease during pregnancy (with reactivation rates of 9% and 8.3%, respectively) and after delivery (with reactivation rates of 36.4% and 41.7%, respectively).

In 7 patients pregnancy ended in spontaneous miscarriage. Miscarriage was significantly less common in patients with UC (p = 0.008; OR: 0.3). No cases of malformations or perinatal morbimortality were recorded.

Conclusion

IBD underwent changes during pregnancy and after delivery in 19.2% and 37.4% of the cases, respectively. These changes were more common in patients with UC. In CD, prior surgery was a risk factor for disease modification during pregnancy. In UC, disease modification during pregnancy was a strong risk factor for disease flare-up in the year following delivery. No differences were observed in the course of IBD between patients who discontinued medication and those who do not – this probably being conditioned by the small number of women who suspended therapy, and the good previous control of IBD. The miscarriage rate was 7%, and proved significantly lower in patients with UC.