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P211. Interaction between pregnancy and inflammatory bowel disease in a Portuguese series of patients

D. Trabulo1, C. Martins1, S. Ribeiro1, C. Cardoso1, J. Mangualde1, I. Cremers1, A.P. Oliveira1, 1Centro Hospitalar de Setúbal – Hospital de São Bernardo, Gastroenterology, Setúbal, Portugal

Background

Most women with inflammatory bowel disease (IBD) are in fertile age which is a serious concern for doctors and patients. We evaluated the influence of pregnancy on IBD activity and the interaction of IBD with fertility and pregnancy.

Methods

Retrospective chart review and interviews of female patients with Crohn's disease (CD) and ulcerative colitis (UC), in fertile age, followed at outpatient clinic since 1980. Activity of the disease during pregnancy, in the preceding 3 months and 3 months after the delivery was classified according to Truelove–Witts index for UC and the Harvey–Bradshaw index for CD. Preterm delivery, low birth weight, congenital anomalies, miscarriages, type of delivery, pregnancy complications and drug administration during pregnancy were also investigated. The chi-square and Fisher's exact test (significance level of 5%) were adopted.

Results

We analyzed 101 pregnancies in 87 patients, 56 pregnancies occurring after the diagnosis with IBD (UC in 22 and CD in 34 pregnancies). Most patients (87.5%) were in remission at the time of conception. Comparing the number of pregnancies before and after diagnosis of IBD, we found a 8.28% reduction of fertility (1.45 to 1.33 pregnancies/woman, p = 0.19). From the 87 women considered, 40 didn't want to get pregnant after the diagnosis. Fifteen patients pointed out that they already had children and 6 were influenced by factors related to the disease. During pregnancy, inflammatory activity remained unchanged for the majority of women, with no significant differences between the two types of disease (p = 0.27). Moreover, there were no differences in disease activity between the three months before pregnancy and during pregnancy (p = 0.30). However, in 51.8% of cases, the disease activity worsened in the three months after delivery, compared to the situation during pregnancy (p = 0.00). Only 15 patients continued therapy during pregnancy: aminosalicylates (8), corticosteroids (2), azathioprine (3), infliximab (1) and metronidazole (1).

There were no significant differences in mortality, low birth weight, prematurity (p = 1.00, for each), type of delivery (p = 0.147) and abortions (p = 0.69) before and after the diagnosis of IBD. There was no record of congenital anomalies.

Conclusion

In our series, IBD didn't significantly influence fertility, nor had any unfavorable effect on the outcome of pregnancy in most patients. Pregnancy didn't influence disease activity. However, disease activity worsened 3 months after delivery in more than half of our patients.