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Grand Rounds

Is Greater IBD Severity Associated with Worse Pregnancy Outcomes?

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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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Related ObG Topics:

Use of Biologics in Pregnant Women with IBD: Is there an Increased Risk for Infantile Infections?
Meta-analysis: Are Biologics for Chronic Inflammatory Disease Associated with Worse Neonatal Outcomes?
Inflammatory Bowel Disease and Biologic Therapies in Pregnancy

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