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P218. Inflammatory bowel disease and pregnancy; our clinical experience

A. Tezel1, G. Can1, G. Dökmeci1, A. Üstündag1, H.C. Ümit1, A.R. Soylu1, 1Trakya University Hospital, Gastroenterology Department, Edirne, Turkey

Background

Inflammatory bowel disease (IBD) is more commonly seen in fertile women. Consequently physicians increasingly encounter with problems related to pregnancy. In the literature, 66% of patients becoming pregnant during remission remain in the remission throughout the pregnancy, active disease continues in 70% of patients becoming pregnant during the active disease. Pregnancy complications are seen more frequently in patients with IBD. Therefore, disease activity is very important during pregnancy. We aimed to investigate the disease corse during pregnancy, complications of pregnancy and risk factors associated with IBD.

Methods

The clinical data of IBD patients followed up between 1999–2012 in our clinic was retrospectively evaluated. Statistical analysis was made.

Results

We obtained clinical data related to pregnancy from only 130 of 149 female patients. There were at least one pregnancy in 105 (80.8%) patients. Pregnancy was after IBD diagnosis in 39 (37%) patients. While 25 (64%) patients remained in remission, 14 (36%) patients flared up during pregnancy (Table 1). All the patients except one were induced remission by medical therapy. Total colectomy+ileostomy was applied to a non-responded ulcerative colitis (UC) patient. Number of patients flared up during postpartum period was 5 (20%) (2 in remission, 3 in active during pregnancy). The rate of patients having at least one spontaneous abortus (SA), cesarean section (CS), therapeutic abortion (TA) were 26.3%, 28.2% and 38% respectively. In Turkish population, SA, CS and TA rates are 17%, 45.4% and 11% respectively. When these rates in IBD were compared with normal population, CS rate was found lower (p = 0.046), TA rate was found higher (p = 0.0003) in IBD patients. SA rates were similar. There was no significant difference between active and remission groups during pregnancy in terms of number of pregnancy and abortion, age at diagnosis, type of IBD, UC/Crohn's disease (CD) phenotype and localization, perianal involvement, surgery for IBD, appendectomy, CS, SA, TA, family history, smoking and alcohol usage and education.

Table 1
 No pregnancyNo IBD diagnosis during pregnancyRemission during pregnancyActivation during pregnancyTotal
UC1849201097
CD7175433
Total25662514130

Conclusion

It is reported that activation during pregnancy and IBD surgery increase pregnancy complications. Although lots of risk factors were identified for activation during pregnancy, we could not find any significant risk factors in our IBD patients.