Pregnancy Outcomes in Women With Inflammatory Bowel Disease: A Large Community-Based Study From Northern California

doi:10.1053/j.gastro.2007.07.019

Gastroenterology

Volume 133, Issue 4, October 2007, Pages 1106-1112

https://doi.org/10.1053/j.gastro.2007.07.019 Get rights and content

Background & Aims: The aim of this study was to determine whether pregnancy outcomes differ between women with and without inflammatory bowel disease (IBD) and to determine what risk factors adversely affect outcomes. Methods: We conducted a cohort study of all pregnant women within the Northern California Kaiser Permanente membership between the years 1995 and 2002. We abstracted the records of all pregnancies in women with IBD (exposed cohort) and a random sample of pregnancies from age-matched women without IBD (unexposed cohort) and evaluated risk factors for spontaneous abortion, complications of pregnancy, and adverse newborn events. Results: A total of 461 pregnant women with IBD were matched to 493 unexposed pregnant women. Women with IBD were more likely to have an adverse conception outcome (odds ratio, 1.65; 95% confidence interval, 1.09–2.48), an adverse pregnancy outcome (odds ratio, 1.54; 95% confidence interval, 1.00–2.38), or a pregnancy complication (odds ratio, 1.78; 95% confidence interval, 1.13–2.81); however, the difference between the 2 groups in adverse newborn outcomes was not statistically significant (odds ratio, 1.89; 95% confidence interval, 0.98–3.69). Independent predictors of an adverse outcome included a diagnosis of IBD, a history of surgery for IBD, and non-Caucasian ethnicity. Severity of disease and medical treatments were not associated with an adverse outcome. Conclusions: Women with IBD are more likely to have an adverse outcome related to pregnancy. Disease activity and medical treatment did not predict adverse outcomes in a large, nonreferral population.

Section snippets

Study Design

We performed a cohort study of all pregnant women with IBD and a random selection of pregnant women without IBD who were frequency-matched by age at pregnancy and geographic center. The institutional review boards of the University of California San Francisco and the Kaiser Foundation Research Institute approved this study.

Study Population

The underlying study population included all members of the Kaiser Permanente integrated health care delivery system between the years 1995 and 2002. The total membership

Overview

A total of 493 pregnant women with IBD (exposed) were matched to pregnant women without IBD (unexposed). Thirty-two initially selected subjects were excluded because the medical record review failed to confirm either IBD or a pregnancy.

Because of matching on age, the mean age at conception was 30 years of age for both groups. There were 300 patients with UC and 154 patients with CD. Very few patients were exposed to biologics or immunosuppressants during pregnancy and conception (4%), whereas

Discussion

Women with IBD are less likely to have a live birth and more likely to have an adverse outcome related to gestation than women without IBD. In particular, adverse conception outcomes (spontaneous or abortion unknown) and pregnancy complications were more likely in women with IBD. However, we did not observe a statistically significant difference in newborn outcomes between the 2 groups. Having IBD, and a history of surgery for IBD, were strong predictors of an adverse outcome when compared with

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The altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD).
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Prospective case-control study.
The case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks).
Fetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls.
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: Supported by the Crohn’s Colitis Foundation of America First Award and supplemental funding, the Foundation for Clinical Research in IBD, the Schoenberg Foundation, the Permanente Medical Group, and the National Institutes of Health (K08 DK002697-05).

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Clinical–alimentary tractPregnancy Outcomes in Women With Inflammatory Bowel Disease: A Large Community-Based Study From Northern California

Section snippets

Study Design

Study Population

Overview

Discussion

Gastroenterol Clin North Am

Gastroenterology

Am J Gastroenterol

Am J Obstet Gynecol

Am J Gastroenterol

Am J Gastroenterol

Am J Gastroenterol

Am J Gastroenterol

Am J Obstet Gynecol

Genetic basis of preterm birth

Front Biosci

Clinical–alimentary tract
Pregnancy Outcomes in Women With Inflammatory Bowel Disease: A Large Community-Based Study From Northern California