Women with inflammatory bowel disease maintain a moderate risk for disease relapse, including flares, in the year after they give birth, according to study results.
Ashwin Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that despite the presence of many risk factors like physiological and psychological stress during the postpartum period, many studies on IBD and pregnancy do not focus on the year after women give birth.
“In addition to the impact of IBD on pregnancy, the effect of pregnancy itself on the course of IBD both before and after delivery is an essential consideration for patients undergoing obstetric counseling,” they wrote. “Despite growing literature on disease behavior during pregnancy, factors that impact the IBD course during the postpartum period have not been well defined.”
Researchers conducted a retrospective review of patients with IBD who underwent successful pregnancy and live birth at two referral centers. They collected data on patient and disease factors before and during pregnancy from medical records, including information on whether therapy was dose-reduced or stopped during each trimester of pregnancy.
Of 206 women included in their analysis (mean age 33.2 years, 53% with ulcerative colitis), Ananthakrishnan and colleagues found that 31.6% (n = 65) experienced a postpartum flare within a year of delivery.
Additionally, investigators determined that factors like disease activity during the third trimester (OR = 6.27; 95% CI, 2.81–17.27), therapy de-escalation during pregnancy (OR = 3; 95% CI, 1.03–8.68) and therapy de-escalation after pregnancy (OR = 4.43; 95% CI, 1.55–12.65) all predicted postpartum flares.
Ananthakrishnan told Healio Gastroenterology and Liver Disease that it is important to focus on maintaining the proper therapy throughout all stages of pregnancy for women with IBD.
“The most important message is to optimize and remain on therapy prior to and during pregnancy as flares were predicted by those who reduced dose or de-escalated therapy either during pregnancy or in the post-partum period,” he said. – by Alex Young
Disclosure: Ananthakrishnan reports serving on scientific advisory boards for AbbVie, Gilead, Merck and Takeda and receiving research support from Pfizer. The other authors report no relevant financial disclosures.