Peripartum Exposure to Biologic Therapy Does Not Impact Postpartum Wound Healing in Women With IBD

Abstract

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.

Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding

“…The secondary outcome of wound-related complications in participants using anti-TNF agents was not significantly elevated (OR=1.18, 95% CI 0.83 to 1.68). Another study identified no greater risk of wound infection with peripartum biologic therapy (n=100)187 or with intra-abdominal surgery 188. Although there are no data to guide the timing of therapy resumption after delivery, we consider it reasonable for this to happen after delivery and before discharge if there are no contraindications.…”

Inflammatory Bowel Disease and Pregnancy

“…Although vaginal delivery has not affected longer term J-pouch functioning, continued pelvic floor pressure and sphincter compromise can affect continence, which may already be present before pregnancy (85,86). It should be noted that many patients experience a grade 1 or 2 tear, especially on their first delivery, but the risk of a grade 3-4 tear remains less than 5% (87). Given the potential impact of perineal trauma, operative assisted vaginal delivery should be carefully considered and, if possible, converting to a cesarean section may be a better option in some patients.…”

“…By planning infusion intervals according to the delivery date, patients would be able to get their infusions at the hospital at the time of delivery. Biologic exposure, specifically infliximab, within 24-48 hours of delivery did not increase the risk of poor wound healing after cesarean or vaginal delivery (87). Consideration for moving infusion-based therapies to the home is often preferred and should be organized before delivery.…”

Clinical advances: pregnancy in gastroenterologic and hepatic conditions

“…Lastly, it should be noted that many patients experience a grade 1 or 2 tear especially on their first delivery but the risk of a grade 3–4 tear remains less than 5% 49. Complicated CD, peripartum disease activity and deescalation of biologics during pregnancy and after delivery are associated with postpartum disease activity and is not encouraged 50…”