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Background Inflammatory bowel disease (IBD) commonly affects women during childbearing years and often requires antepartum therapy. Data regarding effects of biologic exposure on delivery outcomes are limited. We explored whether peripartum biologic exposure impacts wound healing following cesarean section (C-section) and vaginal delivery (VD) in IBD patients. Methods Pregnancy and IBD data from the IBD Preconception and Pregnancy Planning (I-PrePP) Clinic database were collected and analyzed. Primary outcome was frequency of postpartum wound infection in women receiving peripartum biologics, defined as exposure in the third trimester and up to 2 weeks postdelivery relative to nonexposed patients. Secondary outcomes included effect of peripartum biologic timing and IBD phenotype on wound healing. Descriptive statistics summarized data using frequency for categorical variables and median for continuous variables. Univariate analyses tested associations when appropriate. Results Of 100 deliveries (interquartile range, 30–35; median, 33 years old), 58 were C-sections and 42 VDs. Peripartum biologic exposure occurred in 72% (42 of 58) and 57% (24 of 42), respectively. Median time from last dose to delivery was 6 (interquartile range, 4–8) weeks; 21 (32%) received biologics within 72 hours following delivery. Seven infections occurred following C-section among 5 unique CD patients. Peripartum biologic exposure was not associated with infection (4 of 66 [6%] exposed vs 3 of 34 [8.8%] nonexposed; P = .68), nor was disease activity (P = 1.0). Crohn’s disease (P = 0.02), internal penetrating phenotype (P < .001), prior IBD surgery (P = .03), and prior postpartum infection (P = .04) were associated with infection. Conclusions Peripartum biologic exposure does not impair postpartum wound healing; however, patients with more complicated disease phenotypes require close monitoring.

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INTRODUCTION: Women with inflammatory bowel disease (IBD) have an increased risk of developing a postpartum flare. There is limited data regarding the effects of antepartum biologic use on disease activity postpartum. Our objective was to identify risk factors associated with postpartum flares and evaluate the effect of antepartum biologic use on the rate of postpartum flares. METHODS: This was a retrospective study of pregnant patients with IBD who delivered at a single tertiary care institution from 2012 to 2017. Maternal demographics between patients who experienced an IBD flare postpartum versus those who did not were compared using Wilcoxon tests for continuous measures and Fisher’s exact tests for categorical measures. The incidence of postpartum flares was compared between groups defined by exposure and non-exposure to biologics using a Fisher’s exact test. RESULTS: Of the 260 patients included in the analysis, 13 (5%) experienced an IBD flare postpartum. Patients who experienced an IBD flare postpartum were more likely to experience a flare during pregnancy (8/13 [61.5%] versus 29/247 [11.7%], P<.001). There was a significantly increased risk of IBD flare postpartum associated with biologic use in pregnancy (8/70 [11.4%] versus 5/190 [2.6%], p=0.008). CONCLUSION: Increased severity of IBD measured by flares during pregnancy is associated with an increased rate of postpartum flare. The association of biologic use with a postpartum flare is likely due to increased disease severity. Future studies are needed to further evaluate timing of biologic use in utero and its association with postpartum disease activity in patients with IBD.

Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks. Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. Key Points