Pregnancy outcomes in women with inflammatory bowel disease—A population-based cohort study☆,☆☆,★

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Abstract

OBJECTIVE: Our purpose was to assess the frequency of adverse pregnancy outcomes in women with inflammatory bowel disease compared with the general population.

STUDY DESIGN: Of all 239,773 pregnant women with single births in Sweden from 1991 to 1992, 756 women with inflammatory bowel disease could be analyzed for late fetal and infant death, preterm birth, low birth weight, small for gestational age, and cesarean section. Logistic regression analyses was used to estimate the odds ratios.

RESULTS: Pregnancies in women with inflammatory bowel disease were associated with an increased risk of preterm birth at <33 weeks (odds ratio 1.81, 95% confidence interval 1.06 to 3.07) and at 33 to 36 weeks (odds ratio 1.48, 95% confidence interval 1.10 to 1.99); low birth weight <1500 gm (odds ratio 2.15, 95% confidence interval 1.11 to 4.15) or 1500 to 2499 gm (odds ratio 1.57, 95% confidence interval 1.12 to 2.22); small for gestational age (odds ratio 1.40, 95% confidence interval 0.97 to 2.02); and cesarean section (odds ratio 1.51, 95% confidence interval 1.27 to 1.89).

CONCLUSIONS: Inflammatory bowel disease in pregnant women is associated with an increased frequency of adverse pregnancy outcomes. (Am J Obstet Gynecol 1997;177:942-6.)

Section snippets

Material and methods

The Swedish Medical Birth Register held by the National Board of Health and Welfare retrieves prospectively collected data from >99% of all births in Sweden.14 Starting with the first antenatal visit, antenatal, obstetric, and pediatric information is collected on standardized records that are forwarded to the birth register. All births and deaths are matched against a population register with use of the 10-digit number exclusively assigned to every Swedish resident.

Between Jan. 1, 1991, and

Results

Among 239,773 single births in Sweden between 1991 and 1992 there were 756 births in which the mother had a diagnosis of inflammatory bowel disease at the first visit at the antenatal clinic. The distributions of age, parity, and smoking habits are tabulated for both groups in Table I. In pregnancies among women with inflammatory bowel disease there were increased rates of LBW infants, preterm births, and SGA infants (Table II).

As expected, there was a U-shaped relationship between maternal

Comment

With regard to the most serious adverse outcomes, such as late fetal and infant death, in offspring of mothers with inflammatory bowel disease, the result in the current study is reassuring. There were altogether eight cases of death, which does not dramatically differ from that expected. Moreover, eight deaths in 2 years in 756 births of mothers with inflammatory bowel disease indicate that this outcome does not pose any significant problem in everyday clinical practice. However, this study

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    • Cited by (0)

    ☆

    From the Department of Cancer Epidemiology, Uppsala University,a the Department of Surgery, Södersjukhuset,b and the Department of Epidemiology, Harvard School of Public Health.c

    ☆☆

    Reprint requests: Dan Kornfeld, MD, Department of Cancer Epidemiology, Uppsala University, S-751 85 Uppsala, Sweden.

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