Outcomes of Obstetric Hospitalizations Among Women With Inflammatory Bowel Disease in the United States

Mount Sinai IBD Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 11/2008; 7(3):329-34. DOI: 10.1016/j.cgh.2008.10.022
Source: PubMed


Pregnant women with Crohn's disease (CD) or ulcerative colitis (UC) are at increased risk of adverse outcomes compared with pregnant women without these disorders. We estimated the occurrence of pregnancies in women with CD and UC in the United States and compared outcomes between these patients and the non-inflammatory bowel disease (IBD) obstetric population.
By using the 2005 Nationwide Inpatient Sample, we estimated the number of obstetric hospitalizations, deliveries, and Cesarean deliveries in women with CD, UC, and those without IBD. Outcomes included prevalences of Cesarean delivery, venous thromboembolism (VTE), blood transfusion, and malnutrition.
Of an estimated 4.21 million deliveries, 2372 and 1368 occurred in women with CD and UC, respectively. Compared with the non-IBD population, adjusted odds of Cesarean delivery were higher in women with CD (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.44-2.04) and UC (aOR, 1.29; 95% CI, 1.01-1.66). The risk of VTE was substantially higher in women with CD (aOR, 6.12; 95% CI, 2.91-12.9) and UC (aOR, 8.44; 95% CI, 3.71-19.2) vs the non-IBD population. Blood transfusions occurred more frequently in women with CD (aOR, 2.82; 95% CI, 1.51-5.26), whereas protein-calorie malnutrition occurred more frequently in women with CD (aOR, 20.0; 95% CI, 8.8-45.4) or UC (aOR, 60.8; 95% CI, 28.2-131.0).
Adverse pregnancy and maternal outcomes occur more frequently in women with IBD. Measures should be undertaken to reduce maternal complications such as VTE and malnutrition in women with these disorders.

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    ABSTRACT: 248 INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases that have an increasing incidence and prevalence. The etiology of inflammatory bowel disease (IBD) is precisely unknown, but there are complex interactions of genetic, immunological, and environmental factors (1). IBD is characterized by a peak age of onset during the peak reproductive years (2). Approximately 55% of patients are less than 35 years of age at the time of diagnosis. Of these, 25% will conceive for the first time following diagnosis (3). Parenthood is one of the The peak age of onset of inflammatory bowel disease (IBD) is simultaneous with the peak reproductive years. Patients have many concerns about the impact of IBD on fertility and pregnancy outcomes. The most important reason for voluntary childlessness is the fear of side effects from medications for IBD. Decision making for medical therapy is a complex equation. It is important to summarize available infor-mation about the management of IBD during pregnancy and its interactions. Among IBD patients, those undergoing surgery are at risk for reductions in fertility. Patients with ileal pouches–anal anastomosis (IPAA) experience higher rates of infertility. Disease activity at the time of con-ception is the main determinant of the impact of IBD on adverse pregnancy outcomes. In different nations, disease activity and relapse depend on many factors and may even be slightly lower during pregnancy. The recommended mode of delivery in IBD is still controversial. However, there is an increased rate of cesarean sections in women with IBD. Choosing the appropriate method of delivery should be based on the obstetrician's opinion, however active perianal disease and the presence of an ileoanal pouch are two major exceptions. If women remain on their maintenance therapy, there would be no increased risk of a flare-up during the postpartum period. In most patients, maintaining remission with medication outweighs the risks of their adverse effects. However, the pros and cons must be discussed with the patient and deci-sions should be made on an individual basis. Among all drugs used in IBD treatment, only methotrexate (MTX) and thalidomide are contraindicated in pregnancy.
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    ABSTRACT: A recent review of the literature suggested that thyroid autoimmunity is statistically associated with preterm delivery. This observation raises a number of follow-up questions, among them whether autoimmune function, in general, predisposes to premature delivery. A review of the English literature for the last 10 years, via PubMed search, finds strong supportive evidence for such a hypothesis. Since the fetal-placental unit represents a (semi) allograft within a maternal (allograft) recipient, it is reasonable to assume that it is subject to similar immunologic tolerance (and failure thereof) as solid organ transplants. As autoimmune responses represent a normal feature of tolerance failure in organ transplantation, similar autoimmune responses can also be expected with failure of tolerance of the fetal-maternal graft. The association of premature (and possibly also term) labor with autoimmune function may, therefore, be the consequence of abnormalities in normal fetal-placental tolerance, leading to uterine activation and labor.
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