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P133 Pregnancy in inflammatory bowel disease: experience of a Chilean cohort

P. Núñez1, E. Sepúlveda2, D. Simian3, C. Figueroa3, L. Flores3, P. Ibáñez3, U. Kronberg4, J. Lubascher3, G. Pizarro3, R. Quera3

1San Juan de Dios Hospital, Gastroenterology Department – IBD Fellow Clínica Las Condes, Santiago, Chile, 2Clínica Las Condes, Gynecology and Obstetrics Department, Santiago, Chile, 3Clínica Las Condes, Gastroenterology Department – Inflammatory Bowel Disease Program, Santiago, Chile, 4Clínica Las Condes, Surgery Department, Colorectal Unit – Inflammatory Bowel Disease Program, Santiago, Chile

Background

In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during their reproductive age. IBD in remission is the ideal scenario when planning a pregnancy. Here, we describe the demographic, clinical and pregnancy/childbirth characteristics in patients with IBD treated at a tertiary centre in Chile between 2017 and 2019.

Methods

Observational, analytic study. We retrospectively reviewed women diagnosed with IBD who were pregnant or delivered during the study period. Demographic, clinical, obstetric and delivery data were obtained from the IBD registry, approved by the local IRB. Descriptive statistics and association tests performed (χ2, p < 0.05).

Results

Forty-six women with IBD were included (Tables 1). At the beginning of pregnancy, 19 (41%) had active disease and 27 (59%) were in remission. Of those with active disease, 8 (79%) remained active and six had spontaneous abortions. In those who were in remission, 20 (74%) remained in this condition. Six patients (13%) discontinued treatment (four based on external medical advice, two on her own). Preconception counselling was performed in 16/40, group with a higher percentage of remission during pregnancy (69% vs. 25%, p = 0.006). Pregnancy outcomes by disease activity are presented in Figure 1. Patients who had a flare during pregnancy had newborn with lower weight compare with the group that always remained in remission (2,945 vs. 3,323 g; p = 0.007).

Table 1. Demographic and IBD clinical characteristics of women

VariableN = 46 (%)
Age (median; range) 32 (24–41)
Diagnosis
Ulcerative colitis33 (72)
Crohn’s disease12 (26)
Non-classifiable IBD1 (2)
Years of disease (median; range) 6 (1–19)
Montreal classification
Ulcerative colitis (extent)
Pancolitis18 (55)
Left colon9 (27)
Proctitis6 (18)
Crohn’s disease (localisation)
L1: terminal ileon4 (33)
L2: colon3 (25)
L3: Ileocolonic5 (42)
L4: upper gastrointestinal0 (0)
Crohn’s disease (behaviour)
B1: non stricturing non penetrating10 (83)
B2: Stricturing2 (17)
B3: penetrating0 (0)
Perianal disease2
Medications
Biological agents9 (19)
Adalimumab3
Infliximab6
Thiopurines15 (33)
Aminosalicylates22 (48)

Figure 1. Pregnancy outcomes by disease activity.

Conclusion

In this cohort, we observed that pregnancy during remission presents better outcomes and that preconception counselling would allow a better IBD control during pregnancy.