Search

P242 Prior pregnancy outcome is an important determinant of subsequent pregnancy outcome in women with inflammatory bowel diseases

A. Rottenstreich1, S. Fridman Lev2, R. Rotem2, T. Mishael2, B. Koslowsky2, E. Goldin2, S. Grisaru-Granovsky2, A. Bar-Gil Shitrit2

1Hadassah-Hebrew University Medical Center, Department of Obstetrics and Gynecology, Jerusalem, Israel, 2Shaare Zedek Medical Center, IBD MOM unit- Digestive Diseases Institute, Jerusalem, Israel

Background

Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Disease flare throughout gestation are not uncommon and can substantially affect pregnancy outcomes. We aimed at the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD.

Methods

Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011–2018.

Results

Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout the follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn’s disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11–32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 215.52), p < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), p < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalisation during pregnancy (14.7% vs. 0, p = 0.02) and preterm delivery (32.4% vs. 5.7%, p = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 grams, p = 0.03), in those with disease flare as compared with those with maintained remission.

Conclusion

History of disease relapse at previous gestation and periconception disease activity were found as an important predictor of disease flare among IBD women. These data would facilitate adequate counselling and informed management decisions among reproductive-aged IBD women and their treating physicians.