Abstract
Background Women with inflammatory bowel disease (IBD) are at risk of certain pregnancy outcomes such as preterm delivery, infants small for gestational age (SGA), and Cesarean delivery. Whether regional variation in these outcomes exists remains unknown. We aimed to assess the geographical variation in these pregnancy outcomes in women with IBD. Methods All pregnancies in women with and without IBD (2002-2013) were identified using Ontario health administrative datasets. Geographical variation in preterm delivery, infants SGA, and Cesarean delivery was assessed using age-adjusted odds ratios (aOR) with 95% confidence intervals (CI) comparing women with and without IBD, stratified by Ontario's 14 health-service regions, known as Local Health Integration Networks (LHINs). Results 1621 women with IBD (2466 pregnancies) and 855,425 women without IBD (1,280,493 pregnancies) were included. Women with IBD were more likely to have preterm delivery (aOR 1.56, 95% CI, 1.35–1.79), infants SGA (aOR 1.52, 95% CI, 1.23–1.88), and Cesarean section (aOR 1.34, 95% CI, 1.22–1.49). Significant geographical variation in these outcomes was detected, with the highest rates observed in the most northern rural areas (aOR for preterm delivery 2.78 (95% CI, 1.03–7.46), aOR for SGA 5.66 (95% CI, 1.67–19.14), and aOR for Cesarean delivery 2.48 (95% CI, 1.11–5.55)). There were no differences in these outcomes in women with and without IBD in more central urban LHINs. Conclusion Significant regional variation was detected in rates of adverse pregnancy outcomes and Cesarean delivery in women with IBD. Further study is required to determine specific reasons for this variation.
Highlights
Inflammatory bowel disease (IBD) is a chronic inflammatory condition that can affect individuals in the height of their reproductive years [1]. e peak onset of inflammatory bowel disease (IBD) occurs between the second and third decade of life [1], with over half of all patients diagnosed before the age of 35 [2]
Each resident of Ontario is provided a unique identification number based on encrypted health card data, which is used to link health data across various datasets. e Ontario Crohn’s and Colitis Cohort (OCCC) is an inception cohort of IBD patients living in Ontario since 1991, derived from other healthcare administrative databases using validated algorithms with sensitivity and specificity of 76.8% and 96.2%, respectively [15]
IBD cases were further stratified by subtype, ulcerative colitis (UC) or Crohn’s disease (CD), based on the assigned diagnostic codes at the last five of nine outpatient physician visits, which is accurate in 91.1% of cases [15]. e non-IBD control cohort included all other women from the source population who were not registered in the OCCC and had no diagnosis codes for IBD in OHIP or CIHI-DAD
Summary
Inflammatory bowel disease (IBD) is a chronic inflammatory condition that can affect individuals in the height of their reproductive years [1]. e peak onset of IBD occurs between the second and third decade of life [1], with over half of all patients diagnosed before the age of 35 [2]. Ough indications for Cesarean delivery include active perianal disease or prior ileal-anal anastomosis [7], most women with IBD undergo Cesarean delivery due to fetal indications such as failure of descent, breech presentation, and fetal heart-rate deceleration [8] It remains unknown whether geographical variation exists in the risk of these obstetrical outcomes, in Canada, where the prevalence of IBD is amongst the highest in the world [9]. Women with inflammatory bowel disease (IBD) are at risk of certain pregnancy outcomes such as preterm delivery, infants small for gestational age (SGA), and Cesarean delivery. Geographical variation in preterm delivery, infants SGA, and Cesarean delivery was assessed using age-adjusted odds ratios (aOR) with 95% confidence intervals (CI) comparing women with and without IBD, stratified by Ontario’s 14 health-service regions, known as Local Health Integration Networks (LHINs). Further study is required to determine specific reasons for this variation
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