Does Microscopic Inflammation Impact Pregnancy Risks Associated with IBD?
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)
Nationwide cohort study
Swedish national registries
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
With vs without histological inflammation
Clinically active IBD vs not clinically active
Estimate of risk ratio (RR) performed with adjustment for smoking, socio-demographics, and comorbidities (aRR)
Preterm birth: <37 weeks
Small for gestational age (SGA): <10th percentile weight for age
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
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
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)
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
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