Optimizing maternal and neonatal outcomes through tight control management of inflammatory bowel disease during pregnancy: a pilot feasibility study

Jogendran, Rohit; O’Connor, Katie; Jeyakumar, Ajani; Tandon, Pramod; Nguyen, Geoffrey C.; Maxwell, Cynthia; Huang, Vivian

doi:10.1038/s41598-023-35332-z

Cited by 5 publications

(1 citation statement)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, telemedicine significantly reduced health-related costs and healthcare utilization [91,94,95]. In pregnant patients with IBD, Jogendran et al [96] assessed the practicality of managing IBD during pregnancy through remote monitoring with a home FCP test (IBDoc) and a self-assessment tool (IBD Dashboard). The majority of participants (77%) consistently used the tools throughout pregnancy, with the end-of-study questionnaires revealing a preference for the IBDoc home test and an intention to use it in the future.…”

Section: Remote Monitoring In Pregnant Patients With Ibdmentioning

confidence: 99%

Monitoring of Inflammatory Bowel Disease in Pregnancy: A Review of the Different Modalities

Al-jabri,

Wetwittayakhlang,

Lakatos

2023

JCM

View full text Add to dashboard Cite

Inflammatory Bowel Disease (IBD) significantly affects women in their reproductive years. Understanding the relationship between IBD and pregnancy is crucial, given its impact across pre-gestational, gestational, and postpartum phases. Monitoring IBD activity during pregnancy involves various modalities. This review discusses these modalities, focusing on the efficacy and safety of Small Intestine Ultrasound (IUS) as a noninvasive and reliable option. While IUS has gained popularity, its technique-sensitive nature necessitates trained staff for optimal usage.

show abstract

Section: Remote Monitoring In Pregnant Patients With Ibdmentioning

confidence: 99%

Monitoring of Inflammatory Bowel Disease in Pregnancy: A Review of the Different Modalities

Al-jabri,

Wetwittayakhlang,

Lakatos

2023

JCM

View full text Add to dashboard Cite

show abstract

Feasibility of transperineal intestinal ultrasound in assessing ulcerative proctitis during pregnancy

Greeve,

Prentice,

Shelton

et al. 2024

JGH Open

View full text Add to dashboard Cite

This study explored the use of transperineal intestinal ultrasound (TPIUS) for assessment of ulcerative colitis (UC) in pregnancy. 8 pregnant women with UC underwent TP‐US, clinical assessment and fecal calprotectin. TP‐IUS was well tolerated and feasible with adequate rectal views obtained in all trimesters of pregnancy. No correlation between TP‐IUS, clinical, or biochemical rectal disease activity assessment was found in this small cohort. Further studies are required to define the optimal technique and references ranges in the pregnant population.

show abstract

Thiopurine Metabolite Shunting in Late Pregnancy Increases the Risk of Intrahepatic Cholestasis of Pregnancy in Women With Inflammatory Bowel Disease, and Can be Managed With Split Dosing

Prentice,

Flanagan,

Wright

et al. 2024

Journal of Crohn's and Colitis

View full text Add to dashboard Cite

Background and Aims The risk of intrahepatic cholestasis of pregnancy (ICP) is increased in thiopurine exposed pregnancies. Thiopurine ‘shunting’, with a 6-methylmecrcaptopurine (MMP) to 6-thioguanine (TGN) ratio of >11, progresses over pregnancy, and may promote ICP development. We aimed to explore the association between thiopurine exposure and ICP, including the hypothesized impact of thiopurine shunting, and identify risk minimization strategies. Methods This prospective multi-centre cohort study compared thiopurine and biologic monotherapy exposed pregnant participants. Disease activity and obstetric outcome data, thiopurine metabolites, bile acids and transaminases were obtained preconception, in each trimester, at delivery, and post-partum. Thiopurine dose management was at the discretion of the treating physician. Results 131 thiopurine and 147 biologic monotherapy exposed pregnancies were included. MMP/TGN ratio increased from preconception to third trimester (p<0.01), with approximately 25% of participants shunting in pregnancy. Second trimester split-dosing led to a decrease in the median MMP/TGN ratio from 18 (IQR 6-57) to 3 (IQR 2-3.5) at delivery (p=0.04). The risk of ICP was increased in thiopurine exposed pregnancies (6.7% (7/105) vs 0% (0/112), p<0.001), with all ICP cases occurring in the setting of antenatal thiopurine shunting. Thiopurine dose increases (RR 8.10 [95% CI 1.88-34.85] p=0.005) and shunting in third trimester (6.20 [1.21-30.73] p=0.028) and at delivery (14.18 [1.62-123.9] p=0.016) were associated with an increased risk of ICP. Conclusions Thiopurine exposure is associated with an increased risk of ICP, particularly following dose increases antenatally and with shunting in late pregnancy. The latter may be effectively managed with split dosing, although further studies are warranted.

show abstract

Optimizing maternal and neonatal outcomes through tight control management of inflammatory bowel disease during pregnancy: a pilot feasibility study

Cited by 5 publications

References 42 publications

Monitoring of Inflammatory Bowel Disease in Pregnancy: A Review of the Different Modalities

Monitoring of Inflammatory Bowel Disease in Pregnancy: A Review of the Different Modalities

Feasibility of transperineal intestinal ultrasound in assessing ulcerative proctitis during pregnancy

Thiopurine Metabolite Shunting in Late Pregnancy Increases the Risk of Intrahepatic Cholestasis of Pregnancy in Women With Inflammatory Bowel Disease, and Can be Managed With Split Dosing

Contact Info

Product

Resources

About