P291. “IBD MOM”: report of a new concept in the treatment of IBD in pregnancy
A. Shitrit1, S. Granovsky-Grisaru2, T. Adar1, B. Koslowsky1, B. Mazuz1, M. Shenwald1, E. Goldin1, 1Shaare Zedek Medical Center, Digestive diseases institute, Jerusalem, Israel, 2Shaare Zedek Medical Center, Department of obstetrics and gynecology, division of maternal fetal medicine, Jerusalem, Israel
About 25% of women become pregnant after an initial diagnosis of inflammatory bowel disease (IBD). Patients and care givers are challenged by deep concerns on the reciprocal effect of disease and the reproductive outcomes. We planned and established a single center multilevel interdisciplinary concurrent team approach clinic, “IBD MOM” that offers female patients complimentary care with scheduled visits from pre-conception until the postpartum period. We report the outcome of IBD disease activity and pregnancy outcome in patients managed by this unique approach clinic.
This is a prospective cohort study. Medical and perinatal data of the “IBD MOM” Clinic between June 2011 and June 2013 are presented. IBD female patients who were considering pregnancy or during pregnancy were encouraged to apply for consults that provided information and care with regards to fertility therapy, medication safety during pregnancy and breastfeeding, disease evaluation and therapy adjustments and delivery plan. The service was provided in parallel on site by a team including specialists trained in gastroenterology, maternal fetal medicine, general surgery, food regimens, psychology and a coordinator nurse. All data is recorded in the hospital computerized database service.
Seventy-five patients, with a mean age of 29±5 years were included in the IBD MOM program evaluation. During the study period, 207 visits took place: 54 (26%) preconception visits, 130 (63%) during pregnancy and 23 (11%) postpartum checkup, culminating in 13 on going pregnancies, one early abortion and 43 deliveries during the study. At conception 46 patients (82%) were in remission, 50 (89%) continued medical therapy during pregnancy. Relapse during the pregnancy occurred in 22 patients (39%). Therapy adjustment included addition of steroids or anti-TNF in 11 patients (48%), optimizing current treatment in 5 (22%), nutritional support in 4 (17%) and a combination of enteral feeding and steroids in 3 (13%). The median gestational age at delivery was 39 weeks. IBD uncontrolled flare up and poor nutritional status were the cause of late preterm induction of labor (36–37 weeks) in 5 patients (12%). The majority of patients had an uncomplicated vaginal birth while 5 (11.6%) delivered by cesarean section (C/S). All live newborns were healthy with median birth weight of 3040±764 grams and 5′ Apgar scores >7. Thirty-nine (90%) women breast fed. Remission persisted in the postpartum period for most of patients 35 patients (83%).
An integrated single center concurrent multidisciplinary clinic for the management of female IBD patients had a positive impact on the pregnancy rate and outcome.