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P485 Pregnancy and its outcomes in female IBD patients.

S. Chetcuti Zammit1, M. Caruana1, K.H. Katsanos2, G.J. Mantzaris3, M. Cesarini4, U. Kopylov5, L. Zammit1, P. Ellul*1

1Mater Dei Hospital, Department of Gastroenterology, Msida, Malta, 2University of Ioannina School of Medical Sciences, Department of Internal Medicine, Medical School, Ioannina, Greece, 3Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Department of Gastroenterology, Athens, Greece, 4Sapienza University of Rome, Dipartimento di Medicina Interna e Specialità' Mediche, Rome, Italy, 5Sheba Medical Center, Department of Gastroenterology, Tel Hashomer, Israel

Background

Inflammatory Bowel Disease (IBD) typically affects patients during their child-bearing years. Reproductive issues are a key area of concern for female patients. The aim of this study was to determine the outcomes of pregnancy in femaIe IBD patients.

Methods

This was a retrospective study were female patients with IBD were recruited from 5 different European centres. Patients were interviewed through a purposely designed questionnaire.

Results

233 patients were recruited (mean age 40 SD±11.9). The mean age of diagnosis was 31.4 years (SD±11.2). 85.5% patients with ulcerative colitis (UC) had a Montreal classification of E2 or E3. Most Crohn's disease (CD) patients (64.7%) had non-stricturing and non-penetrating disease.

There were a total of 224 pregnancies. 17.2% were pregnant twice, 6.44% were pregnant three times and 1.72% reported 4 pregnancies each. 26.6% had one pregnancy. 63.8% of pregnancies were before the diagnosis of IBD.

There were 0.96 life births/woman (0.82 life births/woman - CD; 1.02 life births/woman - UC) recorded in this study. There was no significant difference in patents with UC or CD. 54.0% of pregnancies were unplanned. This was higher in those who were pregnant after being diagnosed with IBD (p<0.0001). 8.6% of patients reported fertility issues. 9% of patients had an exacerbation of their IBD during pregnancy. Delivery was by caesarian section in 30.8% and by vaginal delivery in 69.2%. Mode of delivery (caesarian) was influenced by the underlying IBD in 12.0%.

Delivery was uncomplicated in the majority of patients (92.0%). Most patients had their delivery between 38 and 40 weeks gestation (81.6%). Mean birth weight was 3.34 kg (1.90 - 4.70kg; SD 0.395). Most births resulted in healthy babies (94.6%). One infant had congenital anomalies (0.44%). 1.34% suffered from developmental delay. 1.75% had low birth weight and 0.89% were born prematurely. One patient (0.45%) suffered a stillbirth. In those having suffered low birth weight, only one patient was on biologic therapy. Her IBD wasn't well controlled prior to pregnancy and her pregnancy wasn't planned. The mother of one baby who suffered preterm birth had exacerbations of IBD during pregnancy and needed hospital admission. 29 miscarriages were reported in this study.

54.4% of IBD patients breastfed their infants.

Conclusion

Although a lower birth rate and breast-feeding rate was present among IBD patients when compared to European data, the rate of low birth weight, caesarian section, still birth and pre-term births was actually lower than the rest of the European population. This data demonstrates that well controlled IBD is an important factor prior to pregnancy and its medications are safe during pregnancies