Preconception care reduces IBD relapse during pregnancy
Preconception care for women with inflammatory bowel disease reduces their risk for relapse during pregnancy by increasing smoking cessation and adherence to medication, according to the results of a prospective study.
Women who received preconception care were also less likely to deliver babies of low birth weight.
“In general, the goal of [preconception care] in IBD patients is to identify and modify medical and behavioral risk factors for adverse maternal and pregnancy outcomes,” researchers wrote. In particular, preconception care for IBD patients involves educating the patient on the importance of conceiving in times of quiescent disease, adjusting IBD medication to be compatible with pregnancy, and promoting general health advice like folic acid intake, smoking cessation and avoiding alcohol.
To determine the effects of preconception care in pregnant women with IBD, researchers evaluated outcomes of 155 pregnancies in 132 women with IBD who received preconception care before pregnancy at the preconception outpatient clinic at Erasmus MC-University Medical Center Rotterdam in the Netherlands, and compared them with 162 pregnancies in 108 women with IBD referred to the clinic after they became pregnant. The preconception care intervention involved a 30- to 45-minute physician-led education session and 3-month follow up visits until conception.
The patients who received preconception care were younger (mean age, 29.7 vs. 31.4 years; P = .001) and more likely to be having their first child (76.1% vs. 51.2%; P = .0001).
Patients who received preconception care were more likely to adhere to their IBD medication during their pregnancy (adjusted OR = 5.69; 95% CI, 1.88-17.27), have adequate intake of folic acid (aOR = 5.26; 95% CI, 2.7-10.26) and quit smoking (aOR = 4.63; 95% CI, 1.22-17.55).
They were also less likely to relapse during pregnancy, regardless of parity, duration of IBD or IBD activity before conception (aOR = 0.51; 95% CI, 0.28-0.95), and were less likely to have babies with low birth weight (aOR = 0.08; 95% CI, 0.01-0.48).
“This study supports the notion that the combination of preconception patient education and subsequent close monitoring can improve both maternal and fetal pregnancy outcomes,” Ryan A. McConnell, MD, and Uma Mahadevan, MD, both from the University of California, San Francisco, wrote in a related editorial. “However, the strength of evidence from this study is limited by the amount of missing data,” with information on disease activity only reported for 76% of pregnancies in the preconception care group. “Active disease in the missing patients could completely nullify the positive findings,” so it is important to replicate these findings in a population with better follow-up, they wrote.
They also noted that “key reproductive counseling concepts” should be incorporated into regular IBD care, considering the potential unpredictability of pregnancy. – by Adam Leitenberger
Disclosures: Two of the researchers report consulting and/or lecture fees from Abbott, MSD, Shire and Ferring. McConnell reports consulting for Janssen. Mahadevan reports consulting and research support from AbbVie, Janssen, UCB, Takeda and Prometheus Labs.