591: The obstetric and neonatal outcomes of inflammatory bowel disease in pregnancy and associated medication use

Abstract

The available inflammatory bowel disease (IBD) literature in pregnancy points to an increased risk of preterm birth (PTB), small for gestational age (SGA), and low birth weight, however there is little data regarding the effects of disease severity and use of biologics in pregnancy and postpartum. Our objective was to evaluate maternal, neonatal, and infectious outcomes categorized by disease severity and effect of immunomodulators in pregnancies affected by IBD. This was a retrospective cohort study of patients with IBD who were pregnant and delivered at a single tertiary care institution from 2012 to 2017. Controls were randomly selected from a set of pregnant patients without IBD during the same time frame. Rates of SGA and PTB were compared between cases and controls using logistic regression controlling for maternal age, BMI, history of PTB and race. Within cases, the incidence of maternal and neonatal composite outcomes were compared between groups defined by disease severity, flares in pregnancy, use of biologics, and use of infliximab postpartum using Chi-square and Fisher’s exact tests. There were 219 patients included for analysis (101 with IBD and 118 without). Patients with IBD were more likely to be older (p=0.0004), had a lower BMI (p=0.0002), and were more likely to be Caucasian (p<0.0001) (Table 1). The rate of PTB was significantly higher in cases (10.5%) compared to controls (1.7%), p=0.01. This remained statistically significant in adjusted analysis (p=0.03). SGA rates were comparable between cases (5.4%) and controls (5.9%), p=0.86. Moderate-severe/severe disease was associated with an increased risk of maternal adverse outcome as compared to mild-moderate disease (88.2% versus 52.8%, p=0.007). In addition, having a flare in pregnancy was associated with increased maternal adverse outcomes (90% versus 55.7%, p=0.04). There was a trend towards significance for increased composite maternal adverse outcomes in patients using biologics (71.4% versus 50.9%, p=0.06, Table 2). The use of infliximab postpartum was not associated with a statistically significant increased risk of maternal infectious outcome (33.3% versus 16.7%, p=0.16). As one would expect, more severe IBD disease and IBD flares during pregnancy are associated with adverse pregnancy outcomes. Additionally, although there was no difference in infectious outcomes using infliximab postpartum, larger studies are needed to confirm these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)