Predictors of disease activity during pregnancy in women with inflammatory bowel disease—a Danish cohort study

Abstract

Summary Background and Aims Inflammatory bowel disease (IBD) activity during pregnancy is associated with adverse pregnancy outcomes. We aimed to identify key clinical characteristics that predict disease activity during pregnancy. Methods Between January 2008 through 2021, we identified all singleton pregnancies among women with IBD recorded in patient and birth registries at a tertiary IBD centre in Denmark. Maternal and infant data were retrieved from medical records. Demographics, Physicians Global Assessment (PGA) of disease activity 6 months prior to pregnancy and in all three trimesters of pregnancy and pregnancy outcomes were recorded. Results In 609 pregnancies, we observed 603 (99.0%) live births. Disease activity in one or more trimesters was seen in 283 women (46.5%). UC phenotype was associated with an increase in risk of disease activity (adjusted OR = 2.6 [1.8–3.9]; p < 0.001). Disease activity within 6 months prior to conceiving (169 women [27.7%]) was associated with an increased risk of continuous disease activity during pregnancy (adjusted OR of 5.3 [3.5–8.2]; p < 0.001). Disease activity during a previous pregnancy was associated with an increased risk of flares in subsequent pregnancies (adjusted OR of 3.2 [1.5–6.6]; p = 0.002). Sustained clinical remission throughout pregnancy was associated with an increased probability of normal birth term, birthweight and low risk of fetal growth restriction (FGR) and stillbirth. Conclusion Predictors for disease activity include disease activity in a previous pregnancy and/or prior to conception, as well as UC phenotype. Reassuringly, women with IBD in remission are not at increased risk of adverse pregnancy outcomes.

Editorial: predictors of disease activity during pregnancy in women with inflammatory bowel disease—a Danish cohort study

“…The authors of this study also found that remission at least 6 months prior to and at conception was a predictor of remission during pregnancy 8 . This is a new finding that extends the suggested time period for quiescent disease prior to pregnancy from 3 months 4,5 .…”

“…9,10 The authors of this study also found that remission at least 6 months prior to and at conception was a predictor of remission during pregnancy. 8 This is a new finding that extends the suggested time period for quiescent disease prior to pregnancy from 3 months. 4,5 A third finding was that ulcerative colitis was associated with a higher risk of flare in comparison to Crohn's disease, which has been noted in prior work.…”

“…The current study by Vestergaard et al 8 assessed risk factors that predict disease activity during pregnancy in patients with IBD to help determine which clinical features should be addressed pre‐conception. In addition, they examined pregnancy outcomes in those experiencing an active disease.…”

“…Whilst the authors of this study note that it is out of the scope of this manuscript, it would be of interest to know the effect of medications and risk of flare, i.e. given more UC patients appeared to be on 5‐ASA whilst more CD patients were on biologics 8 . Perhaps we should be initiating biologics sooner in our female patients during pre‐conception counselling.…”

Editorial: predictors of disease activity during pregnancy in women with inflammatory bowel disease – a Danish cohort study. Authors' reply

“…We thank Drs. Kane and Chowdury for their comments regarding our study on predictors of disease activity during pregnancy in women with inflammatory bowel disease (IBD) 1 …”