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P207. Is medical treatment a risk factor for adverse birth outcomes among women with Crohn's disease?

M. Julsgaard1, M. Nørgaard2, C.L. Hvas1, A. Grosen1, S. Hasseriis2, L.A. Christensen1, 1Aarhus University Hospital, Department of Medicine V, (Gastroenterology and Hepatology), Aarhus C, Denmark, 2Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Denmark

Background

Women with Crohn's disease (CD) may be at increased risk for adverse pregnancy outcomes. Little is known about the risk of adverse birth outcomes following maternal medical treatment during pregnancy. We examined outcomes of pregnancy among women with CD stratified by medical treatment status.

Methods

Women with CD in North Western Denmark, who had given birth between 2000–2005 among a population of 1.6 million. Diagnoses and birth outcome were confirmed by population-based medical databases. Smoking status and medical treatment were investigated by questionnaires. We assessed the validity of self-reported use of medication by comparing the data with data from the regional prescription database.

Results

Of 132 women with CD 105 (80%) fulfilled the questionnaire. Overall, 55 women with CD (52%) reported being under medical treatment during pregnancy (5-ASA, thiopurines, systemic and/or local glucocorticoids). Of these, 48 filled a prescription on relevant medication according to the prescription database, yielding a positive predictive value of 87% (95% CI, 76–95). In multivariate analyses, adjusted for parity and maternal smoking (yes/no), we found that medical treatment did not seem to affect the likelihood for adverse birth outcomes among medical treated women with CD compared with women with CD who did not receive medical treatment during pregnancy (preterm POR 1.01, 95% CI 0.24–4.26; low birth weight POR 1.15, 95% CI 0.21–6.16; caesarean section POR 1.60, 95% CI 0.70–3.66 and congenital malformation POR 0.55, 95% CI 0.09–3.60).

Irrespectively of medical treatment, there was a substantially difference in birth weight between CD non-smokers (3475 grams; 95% CI, 3368–3581) and CD smokers (3257 grams; 95% CI, 3137–3378) (p = 0.008). Among women with CD who received medical treatment, lower birth weight was substantially more common among children of mothers with CD who where smokers compared with non-smokers (p = 0.002) (Table 1). In contrast to smoking, maternal medical treatment during pregnancy did not have a negative influence on the children's birth weight (Table 1).

Table 1. Birth weight among infants born by women with Crohn's disease
CharacteristicMedical treatment during pregnancy (N = 50)No medical treatment during pregnancy (N = 49)
 nBirth weight (g)nBirth weight (g)
  Mean95% CI Mean95% CI
Non-smoker2435043372–36362934503281–3619
Smoker2632303072–33412033243097–3550

Conclusion

Maternal medical treatment for CD during pregnancy seems not to be a risk factor for adverse birth outcome. In contrast to maternal medical treatment during pregnancy, maternal smoking was a predictor for low birth weight.