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Long-Term Disease Course and Pregnancy Outcomes in Women with Inflammatory Bowel Disease: An Indian Cohort Study

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Abstract

Background

The literature on interaction between pregnancy and inflammatory bowel disease (IBD) is inconsistent, and there are no reports on this aspect from Asia. This study evaluated the impact both IBD and pregnancy have on each other in a large cohort of Indian patients.

Methods

In total, 514 females with ulcerative colitis (UC) or Crohn’s disease (CD) aged between 18 and 45 years attending IBD clinic, at our institute, from July 2004 to July 2013 were screened, and patients with data on pregnancy status were included (n = 406). Pregnancies were categorized as either before, after or coinciding with disease onset. Long-term disease course was ascertained from prospectively maintained records. Pregnancy and fetal outcomes were recorded from antenatal records or individual interviews.

Results

Of 406 patients (UC: 336, CD: 70), 310 became pregnant (UC: 256, CD: 54), with a total of 597 pregnancies (UC: 524, CD: 73). More UC patients with pregnancies were in long-term remission than non-pregnant patients (56.7 vs. 43.4 %, p = 0.04). Long-term remission was less frequent in UC patients in whom pregnancy coincided with disease onset than patients with pregnancies before and after/pregnancy after the disease onset (41.4 vs. 62.5 %, p = 0.023). Pregnancies after the disease onset were associated with more cesarean sections and adverse fetal outcomes than pregnancies before disease onset in both UC and CD patients.

Conclusions

Long-term disease course in UC patients was better in pregnant as compared to non-pregnant patients. Among pregnant UC patients, disease course was worst when pregnancy coincided with disease onset. Pregnancy and fetal outcomes were worse in pregnancy after disease onset than pregnancy before disease onset.

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References

  1. Munkholm P. Crohn’s disease–occurrence, course and prognosis. An epidemiologic cohort-study. Dan Med Bull. 1997;44:287–302.

    CAS  PubMed  Google Scholar 

  2. Heetun ZS, Byrnes C, Neary P, O’Morain C. Review article: reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther. 2007;26:513–533.

    Article  CAS  PubMed  Google Scholar 

  3. Baiocco PJ, Korelitz BI. The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol. 1984;6:211–2164.

    CAS  PubMed  Google Scholar 

  4. Khosla R, Willoughby CP, Jewell DP. Crohn’s disease and pregnancy. Gut. 1984;25:52–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Beniada A, Benoist G, Maurel J, Dreyfus M. Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature. J Gynecol Obstet Biol Reprod. 2005;34:581–585.

    Article  CAS  Google Scholar 

  6. Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007;133:1106–1112.

    Article  PubMed  Google Scholar 

  7. Nørgård B, Hundborg HH, Jacobsen BA, Nielsen GL, Fonager K. Disease activity in pregnant women with Crohn’s disease and birth outcomes: a regional Danish cohort study. Am J Gastroenterol. 2007;102:1947–1954.

    Article  PubMed  Google Scholar 

  8. Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn’s disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology. 2000;47:1595–1599.

    CAS  PubMed  Google Scholar 

  9. Nguyen GC, Beuudreau H, Harris ML, Maxwell CV. Outcomes of obstetric hospitalizations among women with inflammatory bowel disease in the United States. Clin Gastroenterol Hepatol. 2009;7:329–334.

    Article  PubMed  Google Scholar 

  10. Lin HC, Chiu CC, Chen SF, Lou HY, Chiu WT, Chen YH. Ulcerative colitis and pregnancy outcomes in an Asian population. Am J Gastroenterol.. 2010;105:387–394.

    Article  PubMed  Google Scholar 

  11. Tandon R, Ahuja V. Inflammatory bowel disease. Delhi: Macmillan Medical Communications; 2014:187–199.

    Google Scholar 

  12. Ahuja V, Tandon RK. Inflammatory bowel disease: the Indian augury. Indian J Gastroenterol. 2012;31:294–296.

    Article  PubMed  Google Scholar 

  13. Pedersen N, Bortoli A, Duricova D, et al. European Crohn-Colitis Organisation-ECCO-Study Group of Epidemiology Committee-EpiCom. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women. Aliment Pharmacol Ther. 2013;38:501–512.

    Article  CAS  PubMed  Google Scholar 

  14. Agret F, Cosnes J, Hassani Z, et al. Impact of pregnancy on the clinical activity of Crohn’s disease. Aliment Pharmacol Ther. 2005;21:509–513.

    Article  CAS  PubMed  Google Scholar 

  15. Van Assche G, Dignass A, Panes J, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis. 2010;4:7–27.

    Article  PubMed  Google Scholar 

  16. Stange EF, Travis SP, Vermeire S, et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohns Colitis. 2008;2:1–23.

    Article  CAS  PubMed  Google Scholar 

  17. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, eds. (2010) 1. Overview of obstetrics. Williams Obstetrics (23 ed.). McGraw-Hill Medical.

  19. Stillbirths. World Health Organization. Retrieved 2016.09.29.

  20. American College of Obstetricians and Gynecologists. Definition of term pregnancy. Committee Opinion No. 579. Obstet Gynecol. 2013;122:1139–1140.

    Article  Google Scholar 

  21. Ahuja V, Tandon R. Inflammatory bowel disease in Asia pacific area—a comparison with developed countries and regional difference. J Digest Dis. 2010;11:134–147.

    Article  Google Scholar 

  22. Ng SW, Mahadevan U. Management of inflammatory bowel disease in pregnancy. Expert Rev Clin Immunol. 2013;9:161–174.

    Article  CAS  PubMed  Google Scholar 

  23. Riis L, Vind I, Politi P, et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2006;101:1539–1545.

    Article  PubMed  Google Scholar 

  24. Nwokolo CU, Tan WC, Andrews HA, Allan RN. Surgical resections in parous patients with distal ileal and colonic Crohn’s disease. Gut. 1994;35:220–223.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Castiglione F, Pignata S, Morace F, et al. Effect of pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol. 1996;28:199–204.

    CAS  PubMed  Google Scholar 

  26. Bush MC, Patel S, Lapinski RH, Stone JL. Perinatal outcomes in inflammatory bowel disease. J Matern Fetal Neonatal Med. 2004;15:237–241.

    Article  CAS  PubMed  Google Scholar 

  27. Kane S, Kisiel J, Shih L, Hanauer S. HLA disparity determines disease activity through pregnancy in women with inflammatory bowel disease. Am J Gastroenterol. 2004;99:1523–1526.

    Article  PubMed  Google Scholar 

  28. Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis. 2011;17:795–801.

    Article  PubMed  Google Scholar 

  29. Gould SR, Brash AR, Conolly ME, Lennard-Jones JE. Studies of prostaglandins and sulphasalazine in ulcerative colitis. Prostaglandins Med. 1981;6:165–182.

    Article  CAS  PubMed  Google Scholar 

  30. Mantyh PW, Mantyh CR, Gates T, Vigna SR, Maggio JE. Receptor binding sites for substance P and substance K in the canine gastrointestinal tract and their possible role in inflammatory bowel disease. Neuroscience. 1988;25:817–837.

    Article  CAS  PubMed  Google Scholar 

  31. Cornish J, Tan E, Teare J, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007;56:830–837.

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110029, India

    Rajesh Kumar Padhan, Saurabh Kedia, Sushil Kumar Garg, Sawan Bopanna, V. Pratap Mouli & Rajan Dhingra

  2. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No 3065, Third Floor, Teaching Block, New Delhi, 110029, India

    Govind Makharia

  3. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No 3093, Third Floor, Teaching Block, New Delhi, 110029, India

    Vineet Ahuja

Authors
  1. Rajesh Kumar Padhan
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  2. Saurabh Kedia
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Correspondence to Vineet Ahuja.

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Padhan, R.K., Kedia, S., Garg, S.K. et al. Long-Term Disease Course and Pregnancy Outcomes in Women with Inflammatory Bowel Disease: An Indian Cohort Study. Dig Dis Sci 62, 2054–2062 (2017). https://doi.org/10.1007/s10620-016-4353-5

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  • DOI: https://doi.org/10.1007/s10620-016-4353-5

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