S806 Impact of Biologics Therapy on the Prevalence of Pregnancy Complications Among Women With Inflammatory Bowel Disease: A Nationwide Population-Based Study

Abstract

Introduction: Inflammatory bowel disease (IBD) typically coincides with childbearing years in women. IBD has been established as an independent risk factor for pregnancy complications (PC) and adverse pregnancy outcomes. Biologics have been shown to decrease inflammation among IBD patients however its implications on pregnancy outcomes remain unclear. We sought to compare the prevalence of PC among individuals with or without IBD and to assess whether the risk of PC among patients with IBD is altered by biologics therapy. Methods: We used the IBM Explorys clinical database which includes over 74 million de-identified unique patients across 300 hospitals in the United States. Patient were identified using SNOMED and ICD codes. We included female patients in childbearing age between 18 – 50 years, with history of pregnancy and diagnosis of either Crohn’s disease (CD) or ulcerative colitis (UC). We investigated the prevalence of PC in IBD patients compared to patients with no IBD. PC included pre-eclampsia, pre-term labor and miscarriages. Also, we compared the prevalence of PC in IBD patients who received biologics therapy against other treatment modalities. Odds ratios with 95% confidence intervals were calculated to evaluate the risk of pregnancy complications. Results: Among our cohort of women with history of pregnancy, we identified 23,830 patients with CD and 19,220 patients with UC, of whom 6,550 (27.5%) and 5,520 (28.7%) developed PC, respectively compared to 18.8% in women without IBD, p< 0.0001 to all. Both CD [OR: 1.64; 95% CI: 1.59 – 1.69] and UC [OR: 1.74; 95%CI: 1.69 – 1.80] patients had a significant higher risk of PC compared to patients without IBD. 2,870 (12.0%) patients with CD and 1,520 (7.9%) patients with UC received biologics therapy. Sub-group analysis of the biologics-treated cohort was associated with a significantly lower risk of developing PC in CD [OR: 0.87; 95%CI: 0.79 – 0.95] and UC [OR: 0.81; 95%CI: 0.72 – 0.92], respectively (Figure). Conclusion: In this large retrospective study, we found that the prevalence of pregnancy complications in women with IBD was significantly higher than the general population. Furthermore, we found that IBD patients treated with biologics were significantly less likely to be associated with pregnancy complications. Further studies are required to determine whether biologics therapy may mitigate pregnancy complications risk.Figure 1.: Logistic Regression of pregnancy complications risk in IBD, IBD; inflammatory bowel disease. Immunomodulators included azathioprine, methotrexate and mercaptopurine. Other biologics included natalizumab, ustekinumab and vedolizumab. TNF-a Blockers; tumor necrosis factor-alpha blocker. Table 1. - Demographics of patients with IBD and PC Variable Patients with Pregnancy Complications No Pregnancy ComplicationsN=2,413,580 (%) With IBDN=8,210 (%) Without IBDN=552,000 (%) Age >35 4960 (60.4%) 333,810 (60.5%) 1,322,060 (54.8%) Caucasian 6,460 (78.7%) 337,470 (61.1%) 1,386,960 (57.5%) Smoker 2,180 (26.6%) 72,990 (13.2%) 222,460 (9.2%) Alcohol Abuse 230 (2.8%) 12630 (2.3%) 35,300 (1.5%) T2DM 610 (7.4%) 32,660 (5.9%) 82,280 (3.4%) Hyperlipidemia 1,680 (20.5%) 43,590 (7.9%) 125,010 (5.2%) HTN 280 (3.4%) 13,460 (2.4%) 28,800 (1.2%) CAD 580 (7.1%) 3,870 (0.7%) 13,860 (0.6%) Obesity 4,750 (57.9%) 127,470 (23.1%) 355,890 (14.7%) Intestinal Resection 880 (10.7%) 7,410 (1.3%) 24,130 (1.0%) Colectomy 540 (6.6%) 6,170 (1.1%) 20,350 (0.8%) Pre-eclampsia 1,570 (19.1%) 113,220 (20.5%) NA Pre-term Labor 2,910 (35.4%) 116,860 (21.2%) NA Miscarriage 4,930 (60.0%) 365,420 (66.2%) NA IBD; inflammatory bowel disease, PC; pregnancy complications, T2DM; type 2 diabetes mellitus; HTN; hypertension, CAD; coronary artery disease.