Young Investigator: Evaluation of Crohnʼs Disease Activity in Pregnant Women: A Tertiary Center Experience

Abstract

BACKGROUND: The major of IBD disease's patient are diagnosed in fertile age. The severity of IBD disease activity during pregnancy influences the pregnancy outcomes and so, IBD activity at the time of conception apparently determines the clinical course IBD patients will experience during pregnancy. Some studies revealed that if IBD is controlled at time of conception, the risks of adverse pregnancy outcomes are similar as the general female population; on the other hand, the risk of preterm deliveries, intrauterine growth restriction and low birth weight is higher in women with active IBD. These complications also more often seen in CD patients as compared to UC. In some studies, pregnancy seems to have a beneficial effect in IBD symptoms, mainly when pregnancy occurs during a period of remission. Additionally, it was observed a decrease in Harvey-Bradshaw score in CD patients compared with the disease activity during the previous and the following year. So, with this study, we intend to compare the activity of Crohn disease, using the Harvey-Bradshaw index, during pregnancy with its activity in the previous year and the year before delivery. METHODS: Retrospective and monocentric study, from a prospectively registered cohort of pregnant women with Crohn Disease, in a tertiary reference hospital, between 1999-2017. RESULTS: We included 62 pregnancies of 47 pregnant women with a mean pregnancy age of 30,8 ± 4,4 years. 74,2% of patients had a non stricturing, non penetrating disease, 25,8% was medicated with anti-TNF and 6,5% has developed a disease exacerbation requiring corticotherapy. There were 2 cases of abortion, both in patients with no controlled disease in the time of conception. Analysing the disease activity, we recorded that in 33% of cases, the Harvey-Bradshaw index decreased from the year before pregnancy to pregnancy time (P=0,01); furthermore, this score increased when we compared the pregnancy with the year after delivery, in 60% of patients (P<0,001) with step of remission to mild disease in 14% of cases and to moderate disease in 7% CONCLUSION(S): In this cohort, the activity of Crohn Disease during pregnancy was lower when compared with the time after and before, with a higher number of exacerbations recorded during the year after delivery.