712 Predictors of Ectopic Pregnancy Among Women With Inflammatory Bowel Disease: A Population-Based Cohort Analysis

Abstract

INTRODUCTION: We have previously demonstrated that there is a higher odds of ectopic pregnancy among women with Crohn's disease (CD) but not ulcerative colitis (UC) compared to those without inflammatory bowel disease (IBD) (Gastroenterol 2019 Abstract 1861). We aimed to further characterize underlying predictors and the incidence rates of ectopic pregnancies over time in this cohort. METHODS: A population-based retrospective cohort study using the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) was performed from 2005 to 2014. The NIS is the largest all-payer inpatient health care database in the United States. Unique pregnancies were identified using ICD-9-CM diagnosis and procedure codes. National estimates of ectopic pregnancy were created using appropriate weights for each NIS admission. Multivariable logistic regression was used to evaluate the association of UC and CD with ectopic pregnancy while adjusting for age, race, income, primary insurance, hospital size, hospital region, Charlson-Deyo comorbidity index, obesity, chronic steroid use, smoking status, and prior cesarean section. The trend in the incidence rate of ectopic pregnancy was plotted and compared in IBD and non-IBD patients within the study period. RESULTS: There were significantly higher rates of ectopic pregnancy in patients with CD versus non-IBD patients (1% vs 0.6%, P < 0.001) and patients with UC (0.5%). Observed predictors for ectopic pregnancy included lack of insurance, higher comorbidity index, chronic steroid use, and smoking (Table 1). While the rate of ectopic pregnancy declined in all patients during the time period, the overall incidence rate was highest in patients with IBD (Figure 1). While further exploring this trend, the incidence of ectopic pregnancy in IBD patients was observed to be higher in age groups 31-40 and 41-50 as compared to younger counterparts (Figure 2a) and patients without IBD (Figure 2b). CONCLUSION: Compared to women without IBD, the odds of a pregnancy being ectopic is higher among women with CD but not UC, particularly in patients with lack of insurance, higher comorbidity index, chronic steroid use, and smoking. While the incidence rate of ectopic pregnancy is declining in both patients with and without IBD, older individuals with IBD have an increased risk of ectopic pregnancy compared with younger patients and non-IBD patients. Prospective studies are warranted to further examine this trend and identify mechanisms behind these associations.