Inflammatory Bowel Disease and Biologic Use During Pregnancy and Its Association With Postpartum Disease Activity [20M]

Abstract

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.

The mode of delivery does not influence the occurrence of post-partum perianal disease flares in patients with inflammatory bowel disease

“…This finding may reflect that patients with more severe gastrointestinal involvement and perianal disease are more likely to be on medical therapy. A recent meta-analysis showed five studies (2155 patients) [ 20 , 26 – 29 ] assessed biologic exposure during pregnancy and demonstrated a trend towards an increased odds of post-partum disease activity (OR, 1.41; 95% CI, 0.74–2.70; I2 = 73.0%; Tau2 = 0.36; χ2 = 15.05, P = 0.01) in the setting of biologic exposure [ 24 ]. Again, it is difficult to determine if this is an association reflecting ongoing disease burden or, less likely, causative as a result of medication exposure.…”