A Meta-analysis on the Influence of Inflammatory Bowel Disease on Pregnancy

Julie A Cornish ¹, Emile KW Tan ¹, Julian Teare ², Teoh G Teoh ², Raj Rai ², Susan K Clark ³ and Paris P Tekkis ^1*

¹ Imperial College, London, United Kingdom
² St Mary's Hospital, London, United Kingdom
³ St Mark's Hospital, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: p.tekkis{at}imperial.ac.uk.

Accepted 30 September 2006

Abstract

Objective: Inflammatory bowel disease (IBD) has a typical onset in peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important in the management of pregnancy to aid management. The aim of this study is to provide a clear assessment of risk of adverse outcomes in pregnancy in women with inflammatory bowel disease.

Design: A Medline literature search was performed to identify studies reporting outcomes of pregnancy in IBD patients. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal control patients. Patients and Setting: A total of 3,907 IBD patients (Crohn's 1,952 (63%), ulcerative colitis 1,113 (36%)) and 320,531 controls were reported in twelve studies that satisfied the inclusion criteria.

Results: For women with inflammatory bowel disease there was a 1.87-fold increase incidence in prematurity (<37 weeks gestation) (95%CI 1.52, 2.31; P<0.001) compared with controls. The incidence of low birth weight (<2500g) was over twice that of normal controls (95%CI 1.38, 3.19; P<0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95%CI 1.26, 1.79; P<0.001) and the risk of congenital abnormalities was associated with a 2.37-fold increase (95%CI 1.47, 3.82; P<0.001)

Conclusion: The study has demonstrated a higher incidence of adverse pregnancy outcomes in IBD patients. Further studies are required to clarify which women are at higher risk as this was not determined in the present study. This has an impact on the management of IBD patients in pregnancy, who should be treated as a potentially high risk group.

Keywords: Crohn's disease, Inflammatory bowel disease, Pregnancy, Ulcerative colitis, outcomes

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