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P653. Disease relapse rates during pregnancy – results from the Erasmus MC Rotterdam prospective cohort

A. de Lima1, Z. Zelinkova1, C. van der Ent1, C.J. van der Woude1, 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

Background

Approximately 25% of inflammatory bowel disease (IBD) females are pregnant after IBD diagnosis. If conception occurs during remission, risk of relapse seems equal to non-pregnant pts. Our aim was to evaluate (1) the IBD relapse rate during pregnancy and (2) to evaluate potential risk factors for relapse during pregnancy.

Methods

Between 2008 and 2012, all pregnant IBD pts were prospectively followed at the IBD pregnancy clinic of the Erasmus MC Rotterdam, the Netherlands. In total 100 women visited this clinic prior to their pregnancy for preconceptional counseling on their pregnancy wish in relation to IBD. Another 47 women first visited the outpatient clinic in the first trimester of pregnancy. Medication use, life style, and disease activity were documented. Relapse was defined as disease activity objectified by endoscopy, ultrasound or laboratory findings.

Results

Overall 141 women were included in this follow-up and 112 pregnancies resulted in 104 live births, 7 miscarriages and 1 stillborn. Out of 112 completed pregnancies, 21 women had a relapse (18.8%) (median gestational week = 24, range = 5–35). Relapse was objectified by endoscopy in 14, by ultrasound in 2 and by laboratory findings in 5 women.

Ulcerative colitis (UC) pts had a higher relapse rate compared to Crohn's disease (CD) pts (42.9% and 10.9%, respectively, p = 0.001). Periconceptional disease activity increased the risk of relapse during pregnancy (OR: 6.97 95% CI: 1.08–44.97). Pts who had a relapse vs pts who did not have a relapse were periconceptionally treated with no medication (6/11), steroids (0/3), 5-ASA (3/14), thiopurines (4/15), anti-TNF (3/21), MTX (0/1), anti-TNF and steroids (0/3), steroids and thiopurines (0/2), MTX and anti-TNF (0/1), thiopurines and 5-ASA (4/4), anti-TNF and thiopurines (0/6), anti-TNF, thiopurines and 5-ASA (0/2) and anti-TNF, thiopurines and steroids (1/0). Relapses were treated with prednisone (14), 5-ASA enema's (5), budesonide (1) and enteral nutrition (1). All relapses were treated successfully.

There were no significant differences in gestational age (p = 0.11), birth weight (p = 0.80) and congenital abnormalities (p = 0.49) between pts who had a relapse and pts who remained in remission throughout pregnancy.

Conclusion

This study demonstrates an overall relapse rate during pregnancy of 18.8%. Periconceptional disease activity increases the risk of relapse during pregnancy. UC pts had a higher relapse rate compared to CD pts.