Outcomes of Pregnancies for Women Undergoing Endoscopy While They Were Pregnant: A Nationwide Cohort Study

Abstract

In a nationwide population-based cohort study, we found endoscopy during pregnancy to be associated with increased risk of preterm birth or small for gestational age, but not of congenital malformation or stillbirth. However, these risks are small and likely due to intrafamilial factors or disease activity.

Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

“…Furthermore, we examined small for gestational age (SGA, here defined as a birth weight >2 standard deviations below the sex‐specific mean for gestational age according to Swedish ultrasound‐based reference curves) and congenital malformations (using the same definition as in our recent report on endoscopy during pregnancy; see also http://onlinelibrary.wiley.com/doi/10.1002/hep.29345/suppinfo). We also investigated the risk of induced labor, low birth weight (<2,500 g), cesarean section, Apgar score <7 at 5 minutes, and neonatal death (within 28 days after birth).…”

Evaluating the Safety of Endoscopy During Pregnancy: The Robust Statistical Power vs Limitations of a National Registry Study

“…I commend the landmark study by Ludvigsson et al, 13 who used a large national registry to study this question. Their study population of some 3000 pregnant patients undergoing endoscopy greatly exceeds the several hundred pregnant patients heretofore reported and provides robust power to investigate the statistical significance of uncommon, but important, pregnancy complications, such as congenital malformations.…”

“…For example, this study demonstrates the highly important clinical finding that the relative risk of any major congenital malformation after endoscopy versus no endoscopy during pregnancy is 0.98, with a narrow 95% confidence interval of 0.82 to 1.19. 13 National registry studies require less labor to obtain data than traditional chart-based studies. For our prior report, my colleagues and I had to (1) travel repeatedly to 8 hospitals for an up to 14-year chart study to accumulate 83 pregnant patients undergoing EGD, (2) secure 8 institutional review board approvals, and (3) laboriously, manually abstract the clinical data from the then-paper medical charts before analyzing the data.…”

“…14 In contrast, today clinical researchers can accumulate data on >3000 pregnant patients undergoing endoscopy (1) via a computerized registry from an entire country at 1 setting, at any location without travel via the Internet, (2) secure approval from only 1 institutional review board, which is easily obtained because patient data in a national registry are already deidentified, and (3) access an already populated computerized database without having to review medical charts manually. 13…”

“…First, fewer data are available on individual patients than in studies based on medical chart reviews. For example, the aforementioned study of 83 pregnant patients undergoing EGD reported data on procedure indication, medications, maternal procedural complications, comorbidities, vital signs at beginning endoscopy, and others, 14 which were unavailable for analysis in the Registry Study 13 (Table 1). Second, the medical chart can be re-reviewed in chart-based studies to mine new parameters as becomes necessary.…”