Influence of medical treatment, smoking and disease activity on pregnancy outcomes in Crohn's disease

Abstract

OBJECTIVE. Little is known about predictors for adverse pregnancy outcomes among women with Crohn's disease (CD). In this population-based study, we examined pregnancy outcomes in CD stratified by medical treatment and smoking status while accounting for disease activity. METHODS. In two Danish regions with a population of 1.6 million, we identified 154 CD women who had given birth within a 6-year period. We combined questionnaire data, prescription data, data from medical records and population-based medical databases. We used logistic regression to estimate prevalence odds ratios (POR) for adverse pregnancy outcomes by different predictors. RESULTS. Among 105 (80%) respondents, 55 (52%) reported taking medication during pregnancy. The majority (95%) were in disease remission. The children's mean birth weight did not differ by maternal medical treatment. As expected, smoking was a predictor of low birth weight. Mean birth weight in children of smokers in medical treatment was significantly reduced by 274 g compared with children of non-smokers who received medical treatment. In children of women without medical treatment, this difference was 126 g between smokers and non-smokers. Women in medical treatment did not have an increased risk of preterm delivery (POR 0.71; 95% confidence interval (CI) 0.18-2.79), congenital malformations (POR 0.60; 0.10-3.76) or cesarean section (POR 1.40; 0.63-3.08). CONCLUSIon. In CD, smoking was negatively associated with child birth weight. This association was most pronounced among women who received medical treatment. Maternal medical treatment for CD did not seem to be a risk factor for adverse pregnancy outcomes.

Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease

“…Six (40%) women had mild disease activity (HBI 5-7), while nine (60%) had moderate disease activity (HBI [8][9][10][11][12][13][14][15][16] and no women had severe activity (HBI >16). During pregnancy, five (4.8%) women experienced relapse in CD [18]. Three of the women who experienced moderate disease activity also experienced moderate disease activity during pregnancy including the third trimester, and one of these women had moderate disease activity around conception.…”

“…The study included all women who gave birth to a single child between January 1, 2000 and December 31, 2005 and who were diagnosed with CD at least 1 year prior to their date of conception [4,18]. Multiple births were not included because women who are pregnant with more than one foetus may have more complicated pregnancies and postpartum periods than mothers of a single child [19].…”

“…Reminders were sent twice to each patient. We entered all data from the questionnaires into a database and verified the data by double entry [4,18].…”

“…We obtained information on medical treatment, adherence to medical treatment, disease activity, counselling, lifestyle factors and breast-feeding behaviour through a self-developed questionnaire [4,18].…”

Crohn's disease and pregnancy

“…Риск обострения заболевания у женщин, у которых беременность наступила вне активности БК, сопоставим с риском у небеременных женщин. Во время беременности у женщин с БК, начавшейся еще до зачатия, медикаментозную терапию следует продолжать в течение всей беременности, соблюдать соответствующий режим жизни без курения и с ограниченным потреблением кофе [9,10].…”