Impact of the coronavirus infectious disease (COVID-19) pandemic on the provision of inflammatory bowel disease (IBD) antenatal care and outcomes of pregnancies in women with IBD

Abstract

BackgroundThe impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes.MethodsRetrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters.ResultsWe included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded.ConclusionIBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

“…The majority of studies reported findings from a single hospital site or group of facilities relating to specific and highly variable changes in protocols made during the pandemic [ 13 , [23] , [24] , [25] , [26] , [37] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. This ranged from the institution of new telehealth services [ 29 , 33 , 35 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ], altered hospital admission and discharge protocols [ 27 , 30 , [48] , [49] , [50] ], variance in anaesthetic management [ 27 , 36 , 51 , 52 ], and harmonisation of regional antenatal screening services [ 32 , 53 , 54 ]. Only 14 of the 56 papers reported data from low- or middle-income (LMIC) countries according to World Bank classification [ 13 , 28 , 37 , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ].…”

“…Twenty-five studies [ 13 , 26 , 28 , 29 , 33 , [35] , [36] , [37] , 40 , 42 , [44] , [45] , [46] , [47] , 50 , [56] , [57] , [58] , 60 , [65] , [66] , [67] , [68] , [69] , [70] ] reported on antenatal clinic attendance during the pandemic using a variety of metrics. In several settings, no alteration was made to the standard antenatal care protocol, but decreased antenatal clinic attendance was reported in the majority of studies; in high income settings a decline in face to face contacts was offset by an increase in remote or virtual clinic appointments and the nature but not the number of the appointments varied [ 26 , 29 , 35 , 40 , [42] , [43] , [44] , [45] , 47 , 66 , 70 ].…”

“…Many reports described new provision of virtual services that enabled clinical contact to continue while reducing in-person clinic visits. A wide variety of protocols were described encompassing both routine care and specialist clinics providing care for the hypertensive disorders of pregnancy [44] , diabetes [ 40 , 45 , 72 ], women at risk of preterm birth [65] and women with inflammatory bowel disease [46] . For example, in Nanjing, China, strict screening protocols were introduced for face-to-face antenatal care while telemedicine appointments were offered as an alternative for routine visits, and home monitoring of blood glucose and blood pressure was utilised [28] .…”

Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Children and Expectant Mothers With Inflammatory Bowel Disease

“…In that study, the majority of health care encounters occurred by telephone (68.2%, compared to 3% prior to the pandemic). There was no increase in the number of IBD-related questions to their advice-line, compared to before the pandemic ( 34 ). Preliminary results from a Canadian survey of pregnant people with IBD also found no confirmed cases of COVID-19, although 8 of 29 participants had symptoms suspicious for COVID-19 ( 35 ).…”

“…Very few studies have assessed the impact of COVID-19 on pregnant people with IBD. A registry of IBD prenatal care provided in 13 British hospitals found no confirmed cases of COVID-19 among 244 pregnant people with IBD, and a very low rate of negative pregnancy outcomes ( 34 ). In that study, the majority of health care encounters occurred by telephone (68.2%, compared to 3% prior to the pandemic).…”