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Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort

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Abstract

Background

Malnutrition and weight loss are common features of patients with inflammatory bowel disease (IBD).

Aim

To explore the impact of inadequate gestational weight gain (GWG) on adverse outcomes among IBD mothers in the prospective US pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort.

Methods

The PIANO cohort comprises 559 and 363 pregnant mothers with Crohn’s disease (CD) and ulcerative colitis (UC), respectively, enrolled between 2006 and 2014. The mothers were followed during and after pregnancy to ascertain medication, measurement of disease activity and complications during pregnancy and at delivery. Inadequate GWG was based on US Institute of Medicine recommendations. The associations between inadequate GWG and adverse pregnancy outcomes in maternal IBD were analyzed, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity.

Results

Maternal CD and UC with inadequate GWG had a 2.5-fold increased risk of preterm birth (OR 2.5, CI 1.3, 4.9 and OR 2.5, CI 1.2, 5.6). Furthermore, an increased risk of intrauterine growth restriction and a trend for small for gestational age were demonstrated in CD but not in UC (OR 3.3, CI 1.1, 10.0, OR 4.5, CI 0.8, 24.3, p = 0.08). Flares increased risk of inadequate GWG (OR 1.6, CI 1.2, 2.3, p = 0.002) but did not change the associations between inadequate GWG and adverse pregnancy outcomes in our models.

Conclusion

The US PIANO cohort demonstrated that inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD mothers.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CD:

Crohn’s disease

GWG:

Gestational weight gain

HBI:

Harvey–Bradshaw Index

IBD:

Inflammatory bowel disease

IOM:

The US Institute of Medicine

IUGR:

Intrauterine growth restriction

OR:

Odds ratio

PIANO:

Pregnancy IBD and Neonatal Outcomes

REE:

Resting energy expenditure

SCAI:

Short Colitis Activity Index

UC:

Ulcerative colitis

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Funding

This work was supported by the South-Eastern Norway Regional Health Authority.

Author’s contribution

The concept and design was worked out by MBB, UM, and MHV. Analysis and interpretation of data were carried out by CFM and GAA. MBB wrote the paper. All authors contributed to the drafting and editing of the manuscript. All authors have read and approved the manuscript for publication.

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Correspondence to May-Bente Bengtson.

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Conflict of interest

May-Bente Bengtson, Christopher F. Martin and Geir Aamodt do not have any financial or other relationship(s) to disclose. Morten H Vatn: Advisory Board: Genetic Analysis. Uma Mahadevan: Advisory Board: Janssen. Consultant: AbbVie, Genetech, Janssen, Takeda, UCB. Research Grant: Prometheus, UCB.

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Bengtson, MB., Martin, C.F., Aamodt, G. et al. Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort. Dig Dis Sci 62, 2063–2069 (2017). https://doi.org/10.1007/s10620-017-4547-5

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  • DOI: https://doi.org/10.1007/s10620-017-4547-5

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