182 Inflammatory bowel disease in pregnancy and prevalence of group B streptococcus colonization

Abstract

Half of the nearly 2 million people with inflammatory bowel disease (IBD) in the U.S are women. With improvement in medical management of IBD, more women are achieving pregnancy. These women are at an increased risk of adverse pregnancy outcomes, which increases with worsening disease activity, thus many patients receive corticosteroids and other immunomodulators to control disease during pregnancy. Group B streptococcus (GBS) is a pathogen that impacts both pregnant women and newborns, particularly those born prematurely, and the reported prevalence of GBS in the general population is between 10-25%. As patients with IBD are relatively immunocompromised, they are at increased risk of bacterial infections and there is some evidence that they are also at increased risk for preterm birth (PTB). No data exists on whether women with IBD are at increased risk of GBS, or whether IBD type, or disease activity modulates this risk. The objective of this study is to describe the prevalence of GBS in a large cohort of women with IBD. This was a retrospective cohort study of patients with IBD in pregnancy who delivered at a single tertiary care institution from 2012-2020. Of 413 pregnancies in the cohort, 359 had confirmed GBS culture data available. Prevalence of GBS was calculated for the whole cohort. The prevalence of GBS in our cohort was 34%. Patients with Crohns disease were more likely to be GBS positive when compared to those with Ulcerative Colitis (p=0.011). There was no difference in rate of colonization based on mode of delivery. History of IBD surgery, flare in the 2nd or 3rd trimester, and hospitalization during pregnancy did not increase the risk of GBS colonization. The prevalence of GBS in our IBD cohort was higher than what is reported in the literature. There appeared to be a differential risk based on IBD type, with higher prevalence in patients with Crohns disease. Given this increased prevalence of GBS and changes to microbiome associated with IBD, providers should consider treating these patients who present in labor and are GBS unknown.View Large Image Figure ViewerDownload Hi-res image Download (PPT)