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P178. Outcomes of pregnancies among women with inflammatory bowel disease: results from a single-center cohort

A. Hernandez Camba1, D. Vasquez Carlon2, L. Ramos1, E. Padron2, M. Carrillo Palau1, N. Hernandez Alvarez-Buylla1, E. Quintero Carrion1, 1Hospital Universitario de Canarias, Gastroenterology, La Laguna, SantaCruz de Tenerife, Spain, 2Hospital Universitario de Canarias, Obstetrics and Gynecology, La Laguna, Santa Cruz de Tenerife, Spain

Background

The incidence of Inflammatory Bowel Disease (IBD) seems to increase globally, and because of the typical age of onset between 20 and 40 years, women of chidl-bearing age are frequently affected. Disease activity determinates the choice of treatment, and both disease activity and medical therapy might affect the outcome of these pregnancies. Previous studies have shown that women with IBD have more complications during pregnancy and delivery that non-IBD women. However, very few information regarding fertility and miscarriage in IBD-women were available. The aim of this study was to evaluate the obstetric outcome in a cohort of IBD-women in a tertiary hospital.

Methods

Medical records from ninety-eight IBD women [mean age = 37.12 years, 58 Crohn's disease (CD), 40 ulcerative colitis (UC)] were retrospectively analyzed between January 2007 and June 2013. Women selected had a confirmed diagnosis of IBD and age between 17 and 50 years. Data regarding time from diagnosis, site of disease, medical treatment, previous surgery, parity, mode of delivery, pregnancy and delivery complications and perinatal outcome were evaluated.

Results

Seventy-one women with IBD diagnosed before pregnancy were included [mean age = 36.8 years, 44 Crohn's disease (CD), 27 ulcerative colitis (UC)]. The mean time between diagnosis and pregnancy was 84 months. During pregnancy, 41 were exposed to 5ASA, 32 Azathioprine and 2 Infliximab (1 was suspended in first trimester). Ninety-six pregnancies were recordered (2 twins), and 91 lifebirth (median birth weight 3258 g) of which 7 were preterm. Six pregnancies ended in spontaneous abortion (5CD/1UC) and 1 ectopic pregnancy.

Eleven women had IBD flares during pregnancy developing 1 preterm birth at 35 weeks, 1 oligoamnios and 2 emergency cesarean delivery. 3 gravidic hipermesis, 2 gestational diabetes and 1 cholestasis with preeclampsia were reported.

Twenty-seven percent (30) of patients presented premature rupture of membrane (PRM) (16CD/14UC). 61 women had a vaginal delivery (57 normal delivery, 4 instrumental delivery) and 28 cesarean section (18 emergency cesarean delivery: 7CD/11UC). Nine newborn had an umbilical artery pH < 7.20 and 2 had an Apgar <  6.

Only 1 infectious complication, pielonefritis and severe anemia, was recorded in 1 patient using biological therapy (Infliximab) for severe perianal disease. This woman had a twin pregnancy (obtained with reproductive techniques) with a normal perinatal outcome.

Conclusion

Conclusions:

  • In our cohort, an elevated incidence of cesarean delivery showing predominance in UC was observed.
  • Exist a high incidence of PRM in both EC and UC.
  • Despite suffering a flare during pregnancy, the perinatal results were appropiated.