Fecal Calprotectin: A Biomarker and Predictor of Disease Activity During Pregnancy in Women with IBD

Abstract

Introduction: Active inflammatory bowel disease (IBD) during pregnancy is associated with adverse maternal and fetal outcomes, and therefore requires early optimization of therapy. Women with inflammatory bowel disease (IBD) often have gastrointestinal symptoms during pregnancy, but it is often difficult to differentiate between pregnancy symptoms and active IBD. Fecal calprotectin (FCP) is a noninvasive biomarker of intestinal inflammation used to guide the management of IBD. Whether FCP can be used as a biomarker to identify active disease in pregnant women with IBD who have symptoms is not well understood. The objectives of this study were to determine if FCP is elevated during pregnancy in women with IBD who 1) have active disease or 2) who flare within 3 months of the FCP measurment. Methods: Women with IBD (18 to 45 yrs) were followed pre-conception (PC) and at each trimester of pregnancy (T[n]) in the Preconception and Pregnancy in IBD clinic. Women completed the modified Harvey Bradshaw Index (mHBI) for Crohn's disease and the partial Mayo (pMayo) for ulcerative colitis. Women with mHBI > 5 or pMayo > 2 were identified as having clinically active disease. FCP was determined from the first morning stool sample from each visit using the Quantum Blue High Range Reader. We compared the FCP of the women who 1) had active disease vs inactive disease at each study visit, and 2) who flared within 3 months vs who do not flare within 3 months of the FCP measurement. Results: Of the 60 patients enrolled in the clinic, 9 women with Crohn's disease, and 13 women with ulcerative colitis provided stool samples over 27 visits. FCP was elevated in women with active disease compared to women with inactive disease at each clinic visit (Figure 1). FCP was also elevated in women who flared within 3 months (Figure 2). These findings were mainly seen among women with UC.Figure 1Figure 2Conclusion: Fecal calprotectin is elevated before and during pregnancy in women with active IBD, and in women who will flare within 3 months of FCP measurement. FCP has a potential to be used as a noninvasive biomarker of disease activity during pregnancy in women with IBD - in order to confirm disease activity or to identify those at risk of flaring, so that clincians can optimize the management of IBD preconception and during pregnancy, and thus improve maternal and fetal outcomes.