BACKGROUND AND PURPOSE:

• Mårild et al. (EClinicalMedicine, 2022) investigated whether histological inflammation in addition to clinical findings predicts adverse pregnancy outcomes associated with inflammatory bowel disease (IBD)

METHODS:

• Nationwide cohort study
  • Swedish national registries
• Population
  • Women diagnosed with IBD and a pre-pregnancy (<12 months) colorectal biopsy with vs without histological inflammation (1990 to 2016)
  • Women with IBD 2007 to 2016 with vs. without clinically active disesase (i.e., IBD-related hospitalization, surgery, or medication escalation) <12 months before pregnancy
• Exposures
  • With vs without histological inflammation
  • Clinically active IBD vs not clinically active
• Study design
  • Estimate of risk ratio (RR) performed with adjustment for smoking, socio-demographics, and comorbidities (aRR)
• Primary outcomes
  • Preterm birth: <37 weeks
  • Small for gestational age (SGA): <10^th percentile weight for age

RESULTS:

• With inflammation: 1223 births | Without inflammation: 630 births
• There was an increased risk of preterm birth to women with histological inflammation, compared to those without
  • With: 9.6%
  • Without: 6.5%
  • aRR 1.46 (95% CI, 1.03 to 2.06)
• Histological inflammation was associated with preterm birth in ulcerative colitis but not in Crohn’s disease
  • Ulcerative colitis: aRR 1.64 (95% CI, 1.07 to 2.52)
  • Extensive colitis: aRR 2.37 (95% CI, 1.12 to 5.02)
  • Crohn’s: aRR 0.99 (95% CI, 0.55 to 1.78)
• There was no significantly increased risk of SGA for women with histological inflammation
  • With: 9.6%
  • Without: 8.9%
  • aRR 1.09 (95% CI, 0.81 to 1.47)
• Clinically active IBD: 2110 women | Inactive IBD: 4993 births
• Clinically active disease before pregnancy was linked to preterm birth but not SGA
  • Preterm birth: aRR 1.42 (95% CI, 1.20 to 1.69)
  • SGA: aRR 1.13 (95% CI, 0.96 to 1.32)
• For infants born to women without clinical activity, inflammation was not associated with preterm birth
  • aRR 1.20 (95% CI, 0.68 to 2.13)

CONCLUSION:

• Both histological inflammation and clinical activity in IBD increased the risk of preterm birth, especially for ulcerative colitis
• The authors state

Our data support recommendations to objectively assess endoscopic and histologic disease remission before conception, to optimize management and prevent adverse outcomes of pregnancy and IBD. This is particularly important against the background that in our IBD cohort (1990–2016), two thirds of biopsied women had histological inflammation and one third had clinical disease activity within 12 months before pregnancy

Learn More – Primary Sources:

Histological remission in inflammatory bowel disease and risk of adverse pregnancy outcomes: A nationwide study

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