BACKGROUND AND PURPOSE:

• Yu et al. (BJOG, 2022) characterized inflammatory bowel disease (IBD) trends and their associated risk during delivery hospitalizations

METHODS:

• Cross-sectional study on a nationally representative hospital discharge database
  • National (Nationwide) Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project
  • One of the largest publicly available, all-payer inpatient databases (US)
• Population
  • Delivery hospitalizations in the U.S. 2000 to 2018 National Inpatient Sample
• Exposures
  • IBD presence
  • IBD severity
    • Characterized by the presence of diagnoses such as penetrating and stricturing disease and history of bowel resection
• Study design
  • Temporal trends in IBD were analyzed using regression analyses to estimate the average annual percent change
  • Poisson regression models were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect
  • Adjusted models included relevant demographic, medical and obstetrical characteristics
• Primary outcome
  • Prevalence of IBD
  • Risks of adverse pregnancy outcomes

RESULTS:

• 73,109,790 delivery hospitalizations
  • With IBD: 89,965
• The prevalence of IBD increased between 2000 and 2018
  • 2000: 0.06%
  • 2018: 0.21%
  • Average annual percent change 7.3% (95% CI, 6.7 to 7.9)
• IBD diagnoses with higher severity also increased during the study period
  • 2000: 4.1%
  • 2018: 8.1%
• In adjusted analysis, IBD was associated with increased risk for
  • Preterm delivery
    • aRR 1.50 (95% CI, 1.47 to 1.53)
  • Severe maternal morbidity
    • aRR 1.93 (95% CI, 1.83 to 2.04)
  • Venous thrombo-embolism
    • aRR 2.76 (95% CI, 2.39 to 3.18)
  • Surgical injury during caesarean delivery hospitalization
    • aRR 5.03 (95% CI, 4.76 to 5.31)
• In the presence of a severe IBD diagnosis, risk was further increased for all adverse outcomes

CONCLUSION:

• The prevalence of IBD diagnosis during delivery hospitalizations has more than tripled since 2000
• IBD is associated with adverse pregnancy outcomes, and this risk is exacerbated by IBD severity
• The authors note that
  • IBD diagnoses have generally been increasing in the population
  • However, increase in IBD documented at the time of delivery may also be related to increased fertility among women with IBD
• With respect to severity, the authors state

This may indicate that women who have relatively higher disease burdens are more willing to pursue pregnancy as a result of improving IBD therapies and patient and provider knowledge

Learn More – Primary Sources:

Outcomes during delivery hospitalisations with inflammatory bowel disease

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