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P813 Pregnancy, postpartum and health of newborn in patients with inflammatory bowel disease: experience at a single-centre

M. d. M. Diaz Alcazar*1, P. Martinez Tirado1, A. Garcia Robles1, B. Zuñiga de Mora Figueroa1, A. Roa Colomo1, A. J. Ruiz Rodriguez1, S. Benito Palma1, C. Cardeña Perez1, A. Palacios Perez1

1Hospital Universitario San Cecilio, UGC Aparato Digestivo, Granada, Spain

Background

Inflammatory bowel disease (IBD) affects young women. According to the evidence, IBD does not affect fertility. It is advisable to plan conception in quiescent phase.

Aim: development of pregnancy, postpartum and activity of the disease. Effect of maternal disease in the health of the newborns.

Methods

Retrospective descriptive study. Database from patients of the Hospital Universitario San Cecilio of Granada (Spain). Electronic clinical records between 2012 and 2017 have been reviewed.

Results

There were 68 pregnancies. Description of the population in Table 1. Mean age from diagnosis to pregnancy is 8.83 years.

VariableFrequency
Number of pregnancies: 1; ≥237 women; 13 women
Maternal age (years old): < 35; ≥3539 (57.35%); 29 (42.65%)
Smoking mothers13%
Type of disease: Ulcerative colitis (UC) (Pancolitis; Recto sigmoiditis; Proctitis, Unknown extension), Crohn’s disease (CD) (Ileocolitis; Ileal; Colitis; Antroduodenal and ileocolitis; Unknown extension; Perianal disease)32 patients (47.06%) (16.65%; 37.49%; 28.12%; 18.74%), 36 patients (52.94%) (55.56%; 25%; 13.88%; 2.78%; 2.78%; 22.22%)
Treatment: mesalazine; thiopurines; anti-TNF; without treatment46.87%; 23.44%; 18.75%; 10.94%

Characteristics of the population.

Of the 68 pregnancies, 10 women (14.71%) had history of surgery due to IBD, all of them with Crohn’s disease (CD). In conception, 8/10 were in quiescent phase. During pregnancy, 17.65% of patients stopped their treatment on own initiative or indication of the general practitioner. In all patients anti-TNF could be suspended in the third trimester.

There were seven flare-up (10.29%), and all of them were controlled with corticosteroids. 10.29% women had other complications during pregnancy, but only one was due to IBD (severe thrombocytopenia in a patient in treatment with azatioprine which needed caesarean section). There were two induced abortion and six early miscarriage, being 75% in CD patients.

Most were full-term newborns, there were only three late preterm infants in women with CD. The labour was vaginal delivery in 53 cases and caesarean section in 15 (22.06%), three of them due to perianal disease, and the rest for obstetric reasons. Only one newborn (1.47%) was small for gestational age, they was one of the twins of a multiple gestation. 69.12% mothers were breastfeeding, more frequent in ulcerative colitis (UC) (81,25%) than CD (41,67%).

Any newborn from mothers with UC had any relevant disease, but there were a case of hip dysplasia, one of Rubinstein–Taybi syndrome and another of enterovirus meningitis in infants from mothers with CD.

14.71% of women had flare-up in the year after delivery, being 90% in the six first months.

Conclusion

(1) The frequency of obstetric complications in IBD was similar to general population. Only a case of severe thrombocytopenia and three out of five caesarean sections were due to IBD. (2) Miscarriages and complications in newborns were more frequent in CD. (3) IBD affects young women in reproductive age. In our series, 18% of women stopped treatment during pregnancy. It is required medical advice to avoid suspension of treatment. Most IBD treatments are safe during pregnancy and breastfeeding.