P-056 YI Nutritional Parameters in Pregnant Women with Inflammatory Bowel Disease

Abstract

The Institute of Medicine's guidelines for weight gain in pregnancy are based on women's pre-pregnancy body mass index (BMI). Data suggests that BMI may not be the best indicator for nutritional status in patients with inflammatory bowel disease (IBD) due to discordance among BMI, percentage of ideal body weight, and micronutrient deficiencies. The goal of this study was to determine the frequency with which nutritional data is obtained in pregnant women with IBD and the prevalence of abnormal nutritional parameters among these women based on pre-pregnancy BMI. We retrospectively reviewed the medical records of women with IBD with confirmed pregnancy at the University of Wisconsin School of Medicine and Public Health between January 2008 and October 2014. Subjects were identified using ICD-9 codes for Crohn's disease (CD), ulcerative colitis (UC), indeterminate colitis (IC) and for normal or abnormal pregnancy. Subject demographics, disease characteristics, pregnancy course, and nutritional data were abstracted from electronic health record (Epic Systems 2014 IU1). Descriptive statistics were calculated. Comparison between groups was performed with the student's t test and chi square test where P < 0.05 was considered significant. One hundred and thirty-six eligible patients were identified (CD = 66 [49%], UC = 66 [49%], IC = 4 [3%]). Seventy-nine patients (58%) had normal pre-pregnancy BMI, 36% were overweight or obese, and 5% were underweight. Of the 130 patients with available data, only 18% gained the recommended amount of weight during pregnancy based on pre-pregnancy BMI; 30% gained insufficient weight and 45% gained excessive weight. One hundred 3 patients (76%) saw a gastroenterology provider during pregnancy. Fifty-four patients (40%) had no nutritional parameters checked during pregnancy. Among the patients who had nutritional testing, protein stores were most frequently assessed (40%) followed by vitamin B12 (37%), vitamin D (35%), and iron studies (17%). Thirty-seven (45%) of these patients had at least one abnormal parameter. No difference was found in the prevalence of abnormal nutritional lab testing based on pre-pregnancy BMI. Of the 30 patients with active disease during pregnancy, 10 patients (33%) did not have any nutritional parameters checked. Fifty-nine (43%) patients had pregnancy complications. No difference was found in the proportion of patients with inappropriate weight gain between those with and without a pregnancy complication (P = 0.06). Thirty-five (60%) patients with a complication underwent nutritional assessment. Within this group 68% of women had at least one abnormal nutritional parameter. In our cohort of IBD patients 75% of women did not gain weight appropriately during pregnancy and many women experienced a pregnancy complication. Nutritional testing was not performed on a large number of patients despite follow-up by both obstetric and gastroenterology providers. Abnormal nutritional values were not associated with a single pre-pregnancy BMI category. Among patients with inappropriate weight gain, many patients were not nutritionally assessed using laboratory assessments or nutrition consultation. Further prospective studies are needed to determine the optimal means of assessing the nutritional status of pregnant women with IBD as nutritional deficiencies may increase the risk for a pregnancy complication and their prevalence may not be adequately reflected by pre-pregnancy BMI.