761 Increased Risk of Preeclampsia in Women With Inflammatory Bowel Disease on Anti-TNF Therapy

Abstract

INTRODUCTION: Women with inflammatory bowel disease (IBD) are at an increased risk of adverse pregnancy outcomes. Some observational studies have demonstrated a possible association between IBD and the risk preeclampsia. There is evidence of immune dysregulation in preeclampsia; in particular, upregulation of TNF-α. Our hypothesis was that anti-TNF therapy in pregnancy may decrease the risk of preeclampsia in women with IBD. METHODS: We identified cases of preeclampsia from among patients with IBD followed at a tertiary care center. We selected two random controls with a normotensive pregnancy for each case, matched only on disease type (ulcerative colitis vs. Crohn's). We collected data on age, race, pre-pregnancy hypertension, diabetes, smoking, medication use and disease activity. RESULTS: We identified 9 women with preeclampsia and 18 controls as reported during patient interviews. Demographic and clinical characteristics are shown in Table 1. There was no significant difference in age of diagnosis of IBD, previous diagnoses of hypertension or diabetes, tobacco use, age at delivery, or nulliparity. The majority of women (8/9) stopped their anti-TNFα therapy in the third trimester. Women who developed preeclampsia were more likely to be on thiopurine or biologic therapy during pregnancy (100% vs. 39%, P < 0.01). Other pregnancy complications included preterm delivery in 6 participants (3 in each group) and 1 participant with each of the following: Clostridium difficile colitis, small bowel obstruction, post-partum hemorrhage and intrauterine growth restriction. There was no significant difference between cases and controls in regard to the number of flares during pregnancy. Using univariate logistic regression, we found a significant increase in the odds of having preeclampsia in women on anti-TNF therapy as compared to women not on anti- TNF therapy (OR 6.25; 95% CI 1.09-43.7). CONCLUSION: Women with inflammatory bowel disease on anti-TNF therapy are at an increased risk of developing preeclampsia. This finding suggests that the risk of preeclampsia in IBD may be associated with the severity of the underlying disease and degree of inflammation necessitating the biologic therapy. Despite therapy targeting TNFα, a possible pathologic actor in preeclampsia, women on anti- TNF therapy remain at an increased risk of preeclampsia, though this may be in part due to the fact that most women discontinue anti-TNF therapy in the third trimester.