P154 Temporal relationship of pregnancy to long-term disease course and pregnancy and foetal outcomes: North Indian inflammatory bowel disease cohort study
R. K. Padhan*1, S. Kumar1, S. Kedia1, R. Dhingra1, V. P. Mouli1, S. Bopanna1, S. Shrivastav1, L. Kurrey1, V. Sreenivas2, G. Makharia1, V. Ahuja1
1All India Institute of Medical Sciences, Gastroenterology, New Delhi, India, 2All India Institute of Medical Sciences, Statistics, New Delhi, India
The temporal relationship of pregnancy to long-term disease course and pregnancy and foetal outcomes is studied in North Indian inflammatory bowel disease (IBD) cohort study
Females with ulcerative colitis (UC) or Crohn’s disease (CD) in the 18–45-years-age group attending the IBD clinic were included. Pregnancies were categorised as either before, after, or coinciding with disease onset. Pregnancy outcomes were recorded from antenatal records or individual interviews. Long-term disease course was ascertained from prospectively maintained records
In total, 721 females were enrolled in the IBD clinic from 2004 to 2013. Amongst them, 514 patients were in the reproductive age group (UC 429 and CD 85). Further, 824 pregnancies occurred with available data for 655 pregnancies (UC 529 and CD 126). Median follow-up was 5.9 years in UC and 6.6 years in CD. IBD course was worse in non-pregnant than in pregnant patients (UC p = 0.02 and CD p = 0.4). Disease course was worse when pregnancy precipitated IBD as compared with disease course with pregnancy before or after IBD onset. Caesarean sections occurred more in CD (20.6 %) than UC (4.6%) (p = 0.038) patients. Adverse pregnancy outcomes (abortion, still birth, preterm, and post dated) were found more in pregnancy after onset of both UC and CD and were significantly more frequent in CD than UC (p = 0.003)
Longitudinal cohort data show that UC with pregnancy has a more favourable disease course than UC without pregnancy. A novel observation is that long-term disease course was aggressive when pregnancy precipitated disease onset compared with pregnancy before or after disease onset. Pregnancy and foetal outcomes were worse in pregnancy after disease onset than in pregnancy before disease onset.