P807 Pregnancy and maternal outcomes in a cohort of patients with Inflammatory bowel disease: Encouraging data from a multi-disciplinary clinic in a tertiary center

Abstract

Abstract Background Pregnant women with inflammatory bowel diseases (IBD) are prone to adverse pregnancy outcomes. This study aimed to assess pregnancy outcomes and disease management for pregnant patients with IBD treated at a multi-disciplinary IBD- maternal-fetal medicine (MFM) clinic. Methods This retrospective cohort study included consecutive pregnant patients with IBD having a singleton gestation who attended the IBD-MFM clinic at the Rabin Medical Center between 2012 and 2019. We assessed disease activity and flare management at conception and through pregnancy for the IBD cohort. Pregnancy outcomes of interest included: adverse neonatal and obstetrical outcome and mode of delivery. We also assessed three integrative outcomes: a favorable and a poor pregnancy outcome and an unfavorable maternal outcome. The IBD pregnant cohort was compared with a cohort of non-IBD pregnant women who gave birth at the same shift (1:5-10 control). Multivariable logistic regression was used for risk assessment. Results 141 IBD pregnant patients and 1119 non-IBD pregnant women were included. Mean maternal age 32[±4] years. IBD patients had a higher rate of nulliparity (70% [50/141] vs. 30% [340/1119], p<0.001) and had a lower BMI (21.42 kg/m2 [19.18-23.44] vs. 22.48 [20.31-25.59], p=0.002). All other baseline characteristics were comparable. Among the IBD patients, 60% (85/141) were diagnosed with Crohn’s disease (CD), and the rest with ulcerative colitis (UC). At conception, 88% (124/141) were in clinical remission, 83% (117/141) were on maintenance therapy, and 30.5% (43/141) were on biologics. Through pregnancy, 36.2% (51/141) flared, 14% (20/141) received systemic steroids, and 3% (2/141) initiated a new biologic. Flares were significantly more frequent among patients with UC vs. CD (48.2%, [27/56] vs. 28.2%, [24/85], p=0.015). The majority of neonatal and obstetrical outcomes and all three composite outcomes were comparable between the IBD pregnant and the non-IBD cohorts, table 1. Cesarean delivery was more frequent among the IBD pregnant patients compared with the non-IBD pregnant women (34.8%, [49/141] vs. 24.1%, [270/141], p=0.021). Risk analysis revealed that a diagnosis of IBD was not associated with either a favorable or a poor pregnancy outcome, nor an unfavorable maternal outcome, see table 2. Conclusion In this IBD-pregnant cohort followed at a multi-disciplinary IBD- MFM clinic, outcomes were encouraging and comparable with the non-IBD cohort. A diagnosis of IBD was not associated with pregnancy or maternal outcomes.