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P326. The association between inflammatory bowel disease (IBD) and parity

A. Shitrit1, M. Shaubi2, T. Adar1, B. Koslowsky1, E. Goldin1, S. Granovsky-Grisaru3, 1Shaare Zedek Medical Center, Digestive diseases institute, Jerusalem, Israel, 2Shaare Zedek Medical Center, Department of Obstetrics and gynecology, Jerusalem, Israel, 3Shaare Zedek Medical Center, Department of obstetrics and gynecology, division of maternal fetal medicine, Jerusalem, Israel

Background

IBD diagnosis peaks during reproductive years and often followed by low parity. We aimed to study the association between IBD, parity and perinatal outcomes.

Methods

Cohort study, single center computerized medical records de-identified, constructed as data file, 2005–2012. Included all IBD (ICD 569.89): Crohn's disease (CD) (555.9), Ulcerative colitis (UC) (556.9). IBD severity: activity, medications, adherence to therapy, nutritional support, flare up. Analysis: cohort divided into 3 parity groups: nulliparous, P 2–5, P > 5.

Results

177 IBD women with 250 births (2.75% of total births): 117 (66%) CD, 60 (34%) UC. Maternal age 29.4±5.4 years, GA at delivery (weeks) 38.9±1.74, median parity IQR 2 (1–4). Parity: nulliparas 63 (25.2%), P 2–5 153 (61.2%), P > 5 34 (12.8%). Mode of delivery: vaginal 77.6%, instrumental 6.4%, cesarean 16%. Episiotomy 14.8%. Severe perineal tears (grade 3&4) 0.8%. Neonates: mean birth weight 3140±528 g, Apgar 5′ <7, 1.6%, NICU admission >72 hours, 4.8%. No malformations.

The IBD severity: no drug therapy 105 (42%), 5-ASAs 99 (39.6%), Thiopurines 49 (19.6%), biological agents 16 (6.4%), combined therapy 27 (10.8%). None reported therapy cessation. IBD active: periconceptual 12 (4.8%), during pregnancy 39 (15.6%), at birth 17 (6.8%), active perianal disease 12 (4.8%). Overall flare up during pregnancy 8 (3.2%): surgical procedures 3 (1.2%), parenteral alimentation 2 (0.8%) and enteral nutrition 3 (1.2%).

At conception and at time of birth, parity groups were similar for IBD activity and perianal disease. During pregnancy, nulliparas had significantly more flare ups (p = 0.004). Although nullipara had a higher rate of instrumental delivery and episiotomy, the risk for severe perineal tears correlated significantly only with the presence of active IBD perianal disease (p = 0.091; R = 0.65).

Conclusion

The sentinel in the IBD women reproductive life is the presence of perianal disease at first birth. Additive parity is not detrimental to IBD course and perinatal outcome.