S881 Impact of Inflammatory Bowel Disease on Maternal and Fetal Outcomes

Abstract

Introduction: Inflammatory bowel disease is a disease of young age and incidence is highest during the reproductive years and current estimates are that only one quarter of female IBD patients will conceive. Due to increased incidence of IBD during reproductive years, many studies are performed to assess the impact of IBD on fertility and pregnancy outcomes, but the results from these studies are conflicting. The aim of our study was to assess the burden of adverse maternal and fetal outcomes in IBD patients. Methods: Using National inpatient sample (NIS) database from 2016 to 2018.All patients above age 15 with diagnosis of pregnancy including live or still birth after 20 weeks of gestation with a secondary diagnosis of Ulcerative colitis or Crohn Disease were included in the study. Maternal outcomes of interest were gestational diabetes (GDM), Gestational hypertension and its complications including Pre-eclampsia, Eclampsia and HELLP syndrome and Postpartum hemorrhage. Fetal outcomes studied were fetal growth restriction (FGR), large for gestational age infants (LGA), preterm birth and fetal death. Subgroup analysis was performed on UC and CD patients.The secondary outcomes were length of stay, maternal death, total hospital charges. Results: Multivariable logistic regression analysis was conducted after adjusting for patient and hospital level confounders. Pregnant ladies with IBD had more odds of GDM (AOR 1.55 95% CI 1.04-2.3, P-value 0.02), Gestational hypertension associated complications (AOR 1.35 95% CI 1.06-1.72, P-value 0.01) and postpartum hemorrhage (AOR 1.04 95% CI 0.84-1.29, P-value 0.68). Pregnancies with co-existent IBD lead to FGR (AOR 1.27 95%CI 1-1.63, P-value 0.05), as well more odds of pre-term delivery (< 37 weeks) and LGA infants (AOR, 1.41 95% CI 1.13-1.76 P-value 0.003, AOR 1.05 95% CI 0.79-1.40 P-value 0.69 respectively). IBD was also associated with higher odds of fetal death (AOR 3.21 95% CI 1.72-6.00 P-value < 0.01). Similar results were seen on subgroup analysis of UC and CD. Conclusion: Patients with IBD, CD and UC has worse maternal and fetal outcomes as well increased resource utilization. As IBD is disease of young population and majority of the patients are diagnosed in their 20s and 30s which coincides with the peak fertility period, and it is seen that woman with IBD voluntarily avoid pregnancy due to fear of worse outcomes. We suggest that women who have moderate to severe disease should get pre-conceptional counselling and treated aggressively to obtain remission.Table 1.: Maternal and Fetal outcomes in Inflammatory bowel disease , Ulcerative Colitis and Crohn Disease, Adjusted Analysis.