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* = Presenting author

P247 C-reactive protein is elevated with clinical disease activity during pregnancy in women with Inflammatory Bowel Disease

J. Bal, R. Foshaug, L. Ambrosio, K.I. Kroeker, L. Dieleman, B. Halloran, R.N. Fedorak, V.W. Huang*

University of Alberta, Gastroenterology, Edmonton, Canada

Background

Inflammatory bowel disease (IBD), Crohn's disease (CD) or ulcerative colitis (UC), is a chronic inflammatory condition of the gastrointestinal tract that affects women in their reproductive years. Women with IBD have a risk of flaring their IBD during pregnancy, which is associated with worse maternal and fetal outcomes. C-reactive protein (CRP) is often used as a marker of IBD disease activity, but CRP can also be elevated during healthy pregnancies. In other words, it is unclear whether CRP can be used as a non-invasive biomarker of clinical disease activity in pregnant women with IBD.

The objective of this study was to determine if an elevated CRP is associated with clinical disease activity during pregnancy among women with IBD.

Methods

Female IBD patients (18 to 45yrs) were enrolled pre-conception (PC) or at each trimester of pregnancy (T[n]). At each clinic visit, women were grouped by clinical disease activity, using the Modified Harvey Bradshaw Index (mHBI) for Crohn's disease, and the partial Mayo score (pMayo) for ulcerative colitis. Women with a mHBI>5 or a partial Mayo score >2 were identified as having clinically active disease. CRP was also measured at each clinic visit; only patients who had previously documented CRP elevations (levels greater than 8.00 mg/L) with flares of their IBD were included for analysis. To examine the association of CRP with clinical disease activity, we compared CRP in women with clinically active and non-active disease, at each visit.

Results

Twenty-three women (13 UC and 10 CD) with median age 29.0 yrs who were seen over 52 clinic visits were included for analysis. There were 14 PC visits, 12 T1 visits (median gestational age 9.22 weeks), 13 T2 visits (median gestational age 20.57 weeks), and 13 T3 visits (median gestational age 31.86 weeks). The median CRP was numerically higher in women with clinically active disease compared to those with clinically inactive disease at PC (6.95 vs 2.80 mg/L; p=0.559) and T1 (24.75 vs 6.00 mg/L; p=1.000), respectively. However, the median CRP was lower in women with clinically active disease compared to those with clinically inactive disease at T2 (8.85 vs 12.40 mg/L; p=0.5923), and T3 (5.45 v. 11.90 mg/L; p=0.592), respectively.

Conclusion

Women with IBD who had clinically active disease during preconception and the first trimester of pregnancy had numerically higher CRP levels than women who had clinically inactive disease. This suggests that CRP remains a potential tool for assessing IBD disease activity in the early trimesters of pregnancy.