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* = Presenting author

P508 Pregnancy outcomes in patients with inflammatory bowel disease experiencing flare ups during foetal development

Y. Yokoyama*1, H. Tanaka2, T. Miyazaki1, T. Sato1, M. Kawai1, Y. Kita1, K. Kamikozuru1, M. Iimuro1, N. Hida1, S. Nakamura1

1Hyogo College of Medicine, Department of Inflammatory Bowel Disease, Division of Internal Medicine, Nishinomiya, Japan, 2Hyogo College of Medicine, Department of Obstetrics and Gynaecology, Nishinomiya, Japan

Background

Inflammatory bowel disease (IBD) is a chronic relapsing and remitting health disorder with morbidities that impair function and quality of life. Further, IBD is frequently diagnosed at the childbearing age, and given that the patients require lifelong medication, it is essential to monitor and manage disease activity to ensure normal pregnancy outcome. This investigation was to better understand pregnancy outcomes in patients who experience IBD flare ups during foetal development and may require medical intervention.

Methods

Between January 2011 and November 2015, 38 pregnant patients with IBD who had been treated at our hospital were reviewed in a retrospective setting. Further,16 of the 38 patients had Crohn’s disease (CD) and 22 had ulcerative colitis (UC). In the CD cases, active disease was defined as CD activity index (CDAI) ≥ 150, whereas in the UC cases, active disease was defined as Lichtiger’s clinical activity index (CAI) > 5. The pregnancy and neonatal complications we factored in our investigations included preterm birth (<37 weeks), the need for caesarean section, low birth weight (< 2 500g) and congenital abnormalities.

Results

In total, 40 pregnancy outcomes in the 38 patients were reported and available for review. The mean age was 38.6 ± 9.4 years in the CD group and 32.4 ± 5.5 years in the UC group. In most patients, IBD was inactive before pregnancy (n = 30; 75%). The most common treatment interventions in CD patients included elemental diet (n = 9) and anti-tumour necrosis factor biologics (n = 10), whereas mesalamine was the most common medication in UC patients (n = 21). The flare-up rate during pregnancy was higher in the UC patients (56.5%) as compared with 29.4% in the CD group. Most patients relapsed in the first pregnancy trimester and puerperal period. The rates of preterm birth (10%), low birth weight (25%), and caesarean section (30%) were not strikingly different from the rates in the general, non-IBD population (n = 394), 28.4%, 32.3%, and 46.4% respectively, except congenital abnormality, which was 5% vs 0.2% in the non-IBD population.

Conclusion

This retrospective investigation revealed that IBD flare ups had occurred more frequently in the first pregnancy trimester period as compared with other periods. Further, flare up rate was higher in UC patients than in CD patients, but this outcome is based on small cohorts of patients. Accordingly, IBD patients should be diligently monitored in the first pregnancy trimester. Studies from other territories have reported that IBD patients with active disease have an increased risk of neonatal and pregnancy complications. In this study, except congenital abnormality, the rates of other complications in IBD patients were not different from a non-IBD population.