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Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases

Abstract

Purpose

Disease flare throughout gestation are not uncommon among women with inflammatory bowel diseases (IBD), and can substantially affect pregnancy outcomes. We aimed to evaluate the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD.

Methods

Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011–2018.

Results

Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn's disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11–32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 25.52), P < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), P < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalization during pregnancy (14.7% vs. 0, P = 0.02) and preterm delivery (32.4% vs. 5.7%, P = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 g, P = 0.03), in those with disease flare as compared to those with maintained remission.

Conclusion

History of disease relapse at previous gestation and periconception disease activity were found as important predictors of disease flare among IBD women. These data would facilitate adequate counseling and informed management decisions among reproductive-aged IBD women and their treating physicians.

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Abbreviations

ART:

Assisted reproductive technologies

CD:

Crohn’s disease

GA:

Gestational age

IBD:

Inflammatory bowel diseases

PGA:

Physician global assessment

UC:

Ulcerative colitis

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Acknowledgements

We thank Mrs. Aviya Hoyda and Mrs. Tami Granot for their assistance in data management.

Funding

No external funding was used in this conduct of this study.

Author information

Affiliations

Authors

Contributions

AR: study conception and design, data collection, data analysis and interpretation, drafting the article.

SFL: study conception and design, data analysis and interpretation, treated the patients.

RR: Statistical analysis.

EG, BK: treated the patients, reviewing the manuscript.

SGG: study conception and design, data analysis and interpretation, treated the patients.

TM: study conception and design, data analysis and interpretation, treated the patients.

ABGS: study conception and design, data collection, data analysis and interpretation, treated the patients, drafting the article.

Corresponding author

Correspondence to Amihai Rottenstreich.

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Conflicts of interest

The authors declare that they have nothing to disclose and that they have no financial or non-financial conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local institutional review board of Shaare Zedek Medical Center Helsinki Committee (IRB approval number No. 176–10).

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Rottenstreich, A., Fridman Lev, S., Rotem, R. et al. Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases. Arch Gynecol Obstet 301, 1449–1454 (2020). https://doi.org/10.1007/s00404-020-05557-8

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Keywords

  • Risk factors
  • Pregnancy
  • Inflammatory bowel diseases
  • Disease activity
  • Relapse