Su1325 Women With Inflammatory Bowel Disease Are At Higher Risk of Gestational Diabetes: A Novel Finding

Abstract

BACKGROUND: Women with inflammatory bowel disease (IBD) may be at higher risk of adverse pregnancy outcomes. The present study compares perinatal outcomes between IBD and non IBD pregnant women. METHODS: The population-based Data Integration, Measurement, and Reporting (DIMR) administrative discharge database was used to identify all women (>/= 18 years of age) in the Calgary Health Zone, Alberta with IBD who delivered a baby between January 1st, 2006 and December 31, 2009. Chart review confirmed IBD disease characteristics and pregnancy related outcomes. Data for controls was obtained from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, a cohort of 2000 women. Pregnant women within the APrON registry who did not have a diagnosis of IBD and lived in the Calgary Health Zone were randomly sampled and matched in a 3:1 ratio to IBD cases by age at conception (+/1 year). Standard descriptive methods were reported. Conditional logistic regression was utilized to handle the matched nature of the data. A stepwise model building technique was used, with the final model comprising variables that were both clinically relevant (determined a priori) and statistically significant with P-values <0.05 from the univariate analysis. RESULTS: A total of 116 unique IBD patients were age matched to 381 pregnant women without IBD. Corticosteroids were prescribed in 18.1% of IBD patients, whereas anti-TNF therapy was utilised by 6.0% of CD patients. Gestational diabetes was more commonly diagnosed in IBD (7.0%) as compared to controls (1.8%) (p=0.03). Significantly more IBD patients had a preterm delivery (gestational week <37 weeks) compared to the control population (12.9% vs. 0.3%; p<.0001). Low birth weight was more common in babies born to mothers with IBD (8.7%) as compared to controls (0.8%) (p<0.0001).The proportion of IBD patients undergoing caesarean section was significantly higher (43.1%) than the control group (21%) (p=0.009). On multivariate analysis, women with IBD were independently more likely to have gestational diabetes (OR=4.3; 95% CI: 1.2-16.3), preterm birth (OR=19.7; 95% CI: 2.2-173.9), and a caesarean section (OR= 2.7; 95% CI: 1.6-4.6) after adjusting for age and smoking status. In subgroup analysis IBD patients on steroids were more likely to develop gestational diabetes as compared to controls (OR= 4.5; 95% CI: 1.2-16.8). CONCLUSIONS: IBD patients are at higher risk for serious complications of pregnancy including gestational diabetes and preterm delivery, and are more likely to undergo caesarean section as compared to a healthy age matched population. The finding of a higher risk of gestational diabetes is a novel finding not previously reported in the IBD literature and warrants further study in a prospective IBD cohort. Table 1: Patient characteristics among pregnant women with and without IBD