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DOP023. Preconception care in IBD women leads to less disease relapses during pregnancy

A. de Lima1, Z. Zelinkova1,2, C. van der Ent1, C.J. van der Woude1, 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2University Hospital, 5th Department of Internal Medicine, Gastroenterology Unit, Bratislava, Slovakia

Background

Preconception care is important for all women with a reproductive wish. Preconception care in IBD patients (pts) is besides health promotion and risk behavior reduction also important to increase knowledge on the effects of IBD and drugs on pregnancy outcomes. We assessed whether preconceptional care in IBD pts affects pregnancy outcome.

Methods

From 2008 till 2013, all pts visiting the preconception and pregnancy outpatient clinic (POC) were prospectively followed. For the purpose of this study we compared pts who received preconception care prior to pregnancy (study group), to pts visiting the POC when already pregnant (control group). Patient characteristics, disease- and obstetric history and medication were documented. Number of relapses, folate intake, medication changes, smoking behaviour and pregnancy outcomes were noted.

Results

In the study group (76 CD, 25 UC, 6 IBDU), 107 out of 152 pts got pregnant, resulting in 82 live births, 16 miscarriages, 1 stillbirth and 8 still pregnant at time of analysis. In the control group (71 CD, 30 UC, 2 IBDU), 103 pregnancies resulted in 82 live births, 9 miscarriages, 1 stillbirth, 1 elective abortion, 8 still pregnant at time of analysis and 2 lost to follow-up. The groups were comparable in terms of marital status (p = 0.898), education level (p = 0.265), smoking 3 months before pregnancy (p = 0.498), 5-ASA use (p = 0.1244), corticosteroids use during pregnancy (p = 0.1543) and previous bowel surgery (p = 0.329). Pts in the study group were more often nulliparous (p = 0.007) and more often used thiopurines (p = 0.0011) and anti-TNF (p = 0.0001) during pregnancy. Compared to the control group, pts in the study group more often used folate (44 vs 99, p = 0.0005) and more often quit smoking during pregnancy (3 vs 13 p = 0.0013). In the control group, 8 pts discontinued IBD medication due to fear of side effects on the child, which lead to disease relapse in 1 pt. In the study group, none of the pts discontinued IBD medication at own initiative. Preconception care had a protective effect on disease activity during pregnancy, independent of smoking status, disease duration and peri-conceptional disease activity (Crude OR = 0.441 95% CI: 0.232–0.838, Adjusted OR = 0.455 95% CI: 0.211–0.979).

Conclusion

Preconception care in IBD women is associated with smoking cessation, folate intake and adequate intake of IBD medication during pregnancy and prevents disease relapse.