In the Journals

IBD associated with gestational diabetes, other poor pregnancy outcomes

Photo of Parul Tandon 
Parul Tandon
Photo of Vivian Huang 
Vivian Huang

Pregnant women with inflammatory bowel disease were more likely to have a cesarean delivery and experience certain adverse pregnancy outcomes, according to study findings published in Alimentary Pharmacology & Therapeutics.

Parul Tandon, DO, gastroenterology fellow at the University of Toronto, told Healio Primary Care that among pregnant women with IBD, “the risk of gestational diabetes and preterm prelabor rupture of membranes appears to be increased whereas the incidence of placental diseases remains low.”

Tandon and colleagues conducted a systematic review and meta-analysis to evaluate the risk for adverse maternal, placental and obstetric outcomes in women with IBD. Researchers conducted subgroup analyses to determine risks associated with ulcerative colitis and Crohn’s disease.

A total of 53 studies that included 7,917 IBD pregnancies and 3,253 healthy pregnancies were included in analyses.

Pregnant woman and doctor (Shutterstock) 
Pregnant women with inflammatory bowel disease were more likely to have a cesarean delivery and experience certain adverse pregnancy outcomes, according to study findings published in Alimentary Pharmacology & Therapeutics.
Source: Shutterstock

The pooled incidence of cesarean delivery was 32.5% (95% CI, 26.9-38) in women with IBD and 21% (95% CI, 19.9-22.4) in the general population.

Compared with controls, IBD was associated with a nearly twofold increase in cesarean delivery (OR = 1.79; 95% CI, 1.16-2.77). When analyzed by disease subtype, the increased odds of cesarean delivery remained significant in women with ulcerative colitis (OR = 1.8; 95% CI, 1.21-2.9) but not in those with Crohn's disease (OR = 1.48; 95% CI, 0.94-2.34)

Gestational diabetes was three times more common among women with IBD (OR = 2.96; 95% CI, 1.47-5.98) than in healthy women.

Women with IBD were more likely to experience preterm prelabor rupture of membranes compared with controls (OR = 12.1; 95% CI, 2.15-67.98). However, they were not more likely than controls to experience early pregnancy loss (OR = 1.63; 95% CI, 0.49-5.43).

Researchers did not identify an increased risk for placental-related disorders — including pre-eclampsia, placenta previa, placental abruption, and chorioamnionitis — among women with IBD.

Use of anti-TNF therapy was not associated with developing chorioamnionitis, early pregnancy loss or placenta previa, regardless of whether it was continued into the third trimester.

“[Although] patients are often concerned about medication use during pregnancy, it appears that anti-TNF therapy appears to be safe with respect to maternal- and placental related outcomes,” senior author Vivian Huang, MSc, MD, FRCPC, assistant professor and clinician investigator in the division of gastroenterology at the University of Toronto, told Healio Primary Care.

However, more data are needed on the safety of newer biologic classes, she added.

“To optimize pregnancy outcomes, routine preconception and pregnancy education and care in collaboration with PCPs, gastroenterologists and obstetricians will likely result in better chances of a healthy pregnancy,” Huang said. “The focus of care should be to achieve disease remission prior to pregnancy and to maintain disease remission during pregnancy.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.

Photo of Parul Tandon 
Parul Tandon
Photo of Vivian Huang 
Vivian Huang

Pregnant women with inflammatory bowel disease were more likely to have a cesarean delivery and experience certain adverse pregnancy outcomes, according to study findings published in Alimentary Pharmacology & Therapeutics.

Parul Tandon, DO, gastroenterology fellow at the University of Toronto, told Healio Primary Care that among pregnant women with IBD, “the risk of gestational diabetes and preterm prelabor rupture of membranes appears to be increased whereas the incidence of placental diseases remains low.”

Tandon and colleagues conducted a systematic review and meta-analysis to evaluate the risk for adverse maternal, placental and obstetric outcomes in women with IBD. Researchers conducted subgroup analyses to determine risks associated with ulcerative colitis and Crohn’s disease.

A total of 53 studies that included 7,917 IBD pregnancies and 3,253 healthy pregnancies were included in analyses.

Pregnant woman and doctor (Shutterstock) 
Pregnant women with inflammatory bowel disease were more likely to have a cesarean delivery and experience certain adverse pregnancy outcomes, according to study findings published in Alimentary Pharmacology & Therapeutics.
Source: Shutterstock

The pooled incidence of cesarean delivery was 32.5% (95% CI, 26.9-38) in women with IBD and 21% (95% CI, 19.9-22.4) in the general population.

Compared with controls, IBD was associated with a nearly twofold increase in cesarean delivery (OR = 1.79; 95% CI, 1.16-2.77). When analyzed by disease subtype, the increased odds of cesarean delivery remained significant in women with ulcerative colitis (OR = 1.8; 95% CI, 1.21-2.9) but not in those with Crohn's disease (OR = 1.48; 95% CI, 0.94-2.34)

Gestational diabetes was three times more common among women with IBD (OR = 2.96; 95% CI, 1.47-5.98) than in healthy women.

Women with IBD were more likely to experience preterm prelabor rupture of membranes compared with controls (OR = 12.1; 95% CI, 2.15-67.98). However, they were not more likely than controls to experience early pregnancy loss (OR = 1.63; 95% CI, 0.49-5.43).

Researchers did not identify an increased risk for placental-related disorders — including pre-eclampsia, placenta previa, placental abruption, and chorioamnionitis — among women with IBD.

Use of anti-TNF therapy was not associated with developing chorioamnionitis, early pregnancy loss or placenta previa, regardless of whether it was continued into the third trimester.

“[Although] patients are often concerned about medication use during pregnancy, it appears that anti-TNF therapy appears to be safe with respect to maternal- and placental related outcomes,” senior author Vivian Huang, MSc, MD, FRCPC, assistant professor and clinician investigator in the division of gastroenterology at the University of Toronto, told Healio Primary Care.

However, more data are needed on the safety of newer biologic classes, she added.

“To optimize pregnancy outcomes, routine preconception and pregnancy education and care in collaboration with PCPs, gastroenterologists and obstetricians will likely result in better chances of a healthy pregnancy,” Huang said. “The focus of care should be to achieve disease remission prior to pregnancy and to maintain disease remission during pregnancy.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.