A meta-analysis on the influence of inflammatory bowel disease on pregnancy

Abstract

Background: Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. Aim: To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. Design: The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. Patients and setting: A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. Results: For women with IBD, there was a 1.87-fold increase in incidence of prematurity (,37 weeks gestation; 95% CI 1.52 to 2.31; p,0.001) compared with controls. The incidence of low birth weight (,2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p,0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p,0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p,0.001). Conclusion:The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.

Management of inflammatory bowel disease in pregnancy

“…However, this study failed to take disease activity or medication use into consideration. A 2007 meta-analysis by Cornish et al suggested a 2.37-fold increased risk of congenital abnormalities among children born to women with IBD, but this finding was influenced solely by the Dominitz study [38]. Other studies analyzed by the Cornish meta-analysis found no increased risk of congenital abnormalities, and this has also not been replicated in large population and registry-based studies, including the recent Stephansson studies discussed above [29,40,49,51].…”

“…Large population-based studies have repeatedly shown increased risk of cesarean delivery up to 1.5-times that of the general population among women with CD but not UC [38,39]. This probably reflects the concern of patients and providers for complications around anal sphincter damage, development or worsening of perianal disease and pouch dysfunction in patients with IPAA prior to pregnancy.…”

“…There has been a large volume of literature to suggest that women with IBD are at increased risk of pregnancy complications compared with age-matched non-IBD peers [29,38,41,[46][47][48]. In concordance with these prior findings are two recent Scandinavian population-based studies conducted by Stephansson et Molnár et al looking at pregnancies of UC and CD patients before and after IBD diagnosis (70 and 97 pregnancies, respectively) also concluded that preterm birth (p = 0.008) and low birthweight (p = 0.048) were more common after the diagnosis of IBD [50].…”

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

“…Approximately 2% of women with CD and UC were seen to develop placental abruption in a study on obstetric hospitalizations [49] . The risk of cesarean delivery is also increased in the setting of either UC or CD [48] . According to Ng et al [19] , women with perianal disease should opt for cesarean section, while those without perianal involvement can safely opt for a normal vaginal delivery.…”

“…Expectant mothers with IBD are at a greater risk for several complications including malnutrition, venous thromboembolism (VTE), antepartum hemorrhage, and cesarean delivery [19,47,48] . VTE is increased in women with UC, while antepartum hemorrhage risk is more prevalent in women with CD [47] .…”