DOP72 Pregnancy for IBD-patients with an enterostomy is feasible but is associated with complications

Abstract

Abstract Background As inflammatory bowel disease (IBD) is frequently diagnosed in young adults, the disease often coincides with pregnancy. There are several indications for enterostomies in the treatment of IBD. Literature on enterostomy complications during pregnancy and pregnancy-outcomes remains scarce. Gaining insight in the incidence of complications and the course of these pregnancies serves as a first step in developing guidelines for the difficult question of how, when and by whom complications during pregnancy should be monitored and treated. The aim of this study was to assess enterostomy related complications and pregnancy-outcomes in female IBD patient with an enterostomy during pregnancy. Methods For this multicenter cohort and survey study, all patients who have been pregnant while having an enterostomy and who gave birth between 2016 and 2023 in three Dutch university medical centers were included. Complications of the enterostomy and pregnancy-outcomes were collected retrospectively from electronic patient files. In collaboration with gastroenterologists, surgeons, gynaecologists and IBD-patients, a survey was designed. Through this digital questionnaire, all participants were asked about their experience during pregnancy and any long-term enterostomy related complaints. Results Data was collected on 37 patients (mean age at conception 32.6 years; 64.9% Crohn’s disease (CD), 32.4% ulcerative colitis (UC), 2.7% IBD undetermined (IBD-U)), comprising 48 pregnancies of which four ended in a miscarriage. Enterostomy related complications occurred in thirty of the full-term pregnancies (68.2%), with decreased stoma-output (43.2%), small-bowel obstruction (29.6%) and leakage (25%) being the most prevalent. In a quarter of the pregnancies, surgical revision of the stoma was needed due to obstruction (27.3%), prolapse (27.3) and peristomal herniation (45.6%). A full overview of documented complications can be found in table 1. Of the fourteen women who completed the questionnaire, six reported non-resolved complications at least six months after delivery (42.9%). Eighteen pregnancies ended in a caesarean section (40.9%). There were 45 infants (one gemelli pregnancy), of whom eight (17.8 %) were born prematurely,eight (17.8 %) had low birth weight (17.8%) and eight (17.8 %) were small for their gestational age. Conclusion Being pregnant and giving birth with an enterostomy is feasible, but is in two third of pregnancies associated with complications. A reduced stoma output and leakage can be prevented by early counseling. Proper guidance before, during pregnancy and postpartum is therefore crucial for IBD-patients with an enterostomy.