Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: results from the PIANO registry

Abstract

ObjectiveActive inflammatory bowel disease (IBD) during pregnancy may require the use of corticosteroids. The aim of this study was to investigate the impact of in utero corticosteroid exposure on adverse pregnancy outcomes, congenital malformations, infections and neurocognitive development among offspring of mothers with IBD.DesignUsing the prospective Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes registry, data were collected at each trimester, delivery; and in the 12 months post partum. Bivariate statistics and multivariate logistic regression models compared pregnancy outcomes by corticosteroid exposure.ResultsA total of 1490 mothers with IBD were enrolled, with 1431 live births recorded. Corticosteroid use was associated with increased risk of preterm birth, small for gestational age, low birth weight (LBW), intrauterine growth restriction and neonatal intensive care unit (NICU) admission. On adjusted multivariate models, corticosteroid use was associated with preterm birth (OR 1.79, 95% CI 1.18 to 2.73), LBW (OR 1.76, 95% CI 1.07 to 2.88) and NICU admission (OR 1.54, 95% CI 1.03 to 2.30). Late corticosteroid use (second and/or third trimester) was associated with serious infections at 9 and 12 months (4% vs 2% and 5% vs 2%, respectively, p=0.03 and p=0.001). There were five newborns with in utero corticosteroid exposure born with orofacial clefts versus one without corticosteroid exposure. Developmental milestones were similar across corticosteroid exposure groups.ConclusionIn this prospective pregnancy registry, offspring of women exposed to corticosteroids during pregnancy were more likely to have adverse pregnancy outcomes. This emphasises the importance of controlling disease activity before and during pregnancy with steroid-sparing therapy.

Pregnancy and neonatal outcomes in women receiving calcineurin inhibitors: A systematic review and meta‐analysis

“…The PIANO registry demonstrated that corticosteroid use was significantly associated with increased risks of preterm birth, LBW and neonatal intensive care unit admission. This registry data also revealed that corticosteroid use in second and/or third trimesters was associated with serious infant infection requiring hospitalization, which is consistent with our finding of neonatal death with corticosteroids in metaregression analysis 9 . In our study, the majority of the included patients were organ transplantation recipients and low‐dose prednisone was dominantly prescribed in addition to CNIs to prevent graft rejection, although not all studies showed the type of corticosteroids and its dose.…”

“…A recent prospective Pregnancy in IBD and Neonatal Outcomes (PIANO) registry 8 reported that biologic, thiopurine or combination therapy exposure during pregnancy was not associated with increased adverse maternal or foetal outcomes. However, this registry recently revealed that corticosteroid use was significantly associated with increased risks of preterm birth, LBW and neonatal intensive care unit admission 9 . While previous investigations suggest that CNI‐treated patients may have increased risks of neonatal prematurity or gestational hypertensive disorders, more studies evaluating the safety of CNIs in particular are needed.…”

Immuno-epigenetic signature derived in saliva associates with the encephalopathy of prematurity and perinatal inflammatory disorders

“…Due to small numbers of individual inflammatory risk factors and the frequent overlap of episodes experienced in the preterm group, we created binary outcome measures based on combinations of inflammatory risk factors or conditions experienced, combining infants that experienced three or more morbidities into a single group, resulting in four possible levels for the risk score of 0, 1, 2, or 3 + alongside a term control reference (0 inflammatory episodes). Results are presented firstly unadjusted (model H1), then adjusted for gestational age at birth, infant sex and birthweight z-score (model H2), and then adjusted for gestational age at birth, infant sex and birthweight z-score as well as administration of MgSO4 and corticosteroids in pregnancy (model H3), given these have been identified as potential confounders of the relationship between inflammation and health outcomes in previous studies (83)(84)(85). Results are presented as odds ratios (OR) and 95% confidence intervals (CI) for categorical outcome measures.…”

Changes to UK BCG vaccination schedules with implications for women on biologic medications during pregnancy

“…American guidelines differ somewhat, suggesting only babies exposed to biologics in third trimester need to avoid live vaccines for the first 6 months 3. There is increased use of biologics throughout pregnancy including the third trimester given the results of large registries, including the Pregnancy Inflammatory bowel disease And Neonatal Outcomes (PIANO) registry, which support the safety of antitumour necrosis factor medications and highlight the risks of active disease in pregnancy 4…”