Outcome of Immunosuppressive Treatment in Pregnant IBD Patients

Abstract

Introduction: Inflammatory bowel diseases tend to have a milder course during pregnancy. Patients with more aggressive disease prior to conception are at higher risk of flares during pregnancy and the benefit of immunosuppression outweighs the treatment side effects. A significant number of pregnant IBD patients as well as their healthcare providers delay or unnecessarily stop therapies in these patients. Methods: We performed a retrospective study in a cohort of 17 pregnant IBD patients: 12 Crohn’s disease (CD) and 5 ulcerative colitis (UC). Disease characteristics were established based on Montreal classification, disease activity indices (Harvey Bradshaw, UC DAI), review of endoscopic, radiologic, and laboratory data. Clinical chart review was performed to assess outcome of pregnancy. Results: All patients presented with severe clinical and endoscopic disease within 6 month of their pregnancy. Three quarters of CD patients has extensive ileocolonic disease while 25% had stricturing/fistulizing disease. Eighty percent of the UC patients had severe pancolitis. Fifteen patients initiated anti-TNF therapy (8 infliximab, 2 adalimumab, 5 certolizumab) within 3-6 month of the pregnancy while 2 patients delayed treatment until the second trimester. Patients that delayed therapy continued to experience moderate-severe symptoms and required prednisone treatment prior to initiating certolizumab treatment. Both patients achieved remission following certolizumab treatment. One patient discontinued humira® during her second trimester and later developed a recurrence of fistulizing disease with peritoneal abscess and required surgical intervention. One patient on infliximab developed perianal abscess and underwent surgical drainage with complete remission. All other patients that continued therapy throughout the pregnancy remained in clinical remission. No other infectious of significant side effects were observed in this cohort of patients. One patient on infliximab has lost the pregnancy within the first trimester. All other patients had an uneventful course with regard to the fetal health. Conclusion: Biologic therapy in pregnant IBD patients is safe. Disease control before and during pregnancy results in high quality of life and improved fetal outcome. Ongoing education of both patients and providers with regard to safety of biologic therapy during pregnancy is important. Disclosure - Dr. Razvan Arsenescu Abbvie - Speakers Bureau Dr. Razvan Arsenescu UCB - Consulting fee Dr. Razvan Arsenescu MaunaKea - Consulting Fee.