Pregnancy outcomes in women with inflammatory bowel disease: a 10‐year nationwide population‐based cohort study

Lee, Han H.; Bae, Jung Min; Lee, Bo In; Lee, Kang Moon; Wie, Jeong Ha; Kim, Jin S.; Cho, Young Seok; Jung, Sung Ae; Kim, Sang Woon; Choi, Hwang; Choi, Myung Gyu

doi:10.1111/apt.15654

Cited by 55 publications

(62 citation statements)

References 42 publications

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“… 11 , 12 However, AMH levels are significantly lower during active disease and inversely correlate with the Crohn’s Disease Activity Index, 13 supporting the observation that fertility rates are reduced in active disease. 9 , 14 A nationwide Korean study found a 21% reduced live birth rate in women with moderate-to-severe IBD activity, while birth rates in women with quiescent or mildly active IBD were comparable with women without IBD. 14 IPAA surgery may also impair fertility, with infertility rates rising from 15 to 20% pre-IPAA to 48–63% post-IPAA.…”

Section: Fertilitymentioning

confidence: 99%

“… 9 , 14 A nationwide Korean study found a 21% reduced live birth rate in women with moderate-to-severe IBD activity, while birth rates in women with quiescent or mildly active IBD were comparable with women without IBD. 14 IPAA surgery may also impair fertility, with infertility rates rising from 15 to 20% pre-IPAA to 48–63% post-IPAA. 15 , 16 This is attributed to reproductive organ damage from deep pelvic dissection, formation of scar tissue and adhesions, and the increased prevalence of dyspareunia post-operatively.…”

Section: Fertilitymentioning

confidence: 99%

“… 64 , 82 , 83 The risk of CS delivery is also increased in women with IBD (29–33%) compared with the general population (16–22%), for both elective and emergency indications. 64 , 68 , 76 , 78 , 81 – 83 , 87 – 90 Limited data suggest that compared with women without IBD, women with IBD also have an increased risk of spontaneous abortions (13% versus 6.5%), 68 gestational diabetes (7% versus 2%), 90 , 91 neonatal intensive care unit (NICU) admissions (10% versus 4%), 64 intrauterine growth restriction (IUGR) in women with CD (3% versus 1%), 14 and neonatal death in women with UC (0.4% versus 0.2%). 83 However, multiple other studies have demonstrated no increased risk of early pregnancy loss, perinatal mortality, NICU admissions, low Apgar scores, or placental diseases.…”

Section: Effect Of Ibd On the Pregnancy And Childmentioning

confidence: 99%

“… 5 , 6 , 14 , 59 , 60 , 80 , 83 , 85 , 87 , 92 , 93 A recent Korean study of 2058 women with IBD found that women with quiescent disease had comparable risks of adverse outcomes with women without IBD, while risks were significantly greater for women with moderate-to-severe disease activity. 14 Similarly, another study found that women with active IBD had significantly greater rates of preterm delivery (27% versus 8%) and babies with LBW (32% versus 3%) compared with women with inactive IBD. 87 Active disease has also been implicated in increasing the risk of childhood illnesses; 79 however, no increased risk of congenital abnormalities has been detected.…”

Section: Effect Of Ibd On the Pregnancy And Childmentioning

confidence: 99%

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Review of pregnancy in Crohn’s disease and ulcerative colitis

Laube

Paramsothy

Leong

2021

Therap Adv Gastroenterol

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Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch–anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.

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Section: Fertilitymentioning

confidence: 99%

Section: Fertilitymentioning

confidence: 99%

Section: Effect Of Ibd On the Pregnancy And Childmentioning

confidence: 99%

Section: Effect Of Ibd On the Pregnancy And Childmentioning

confidence: 99%

See 2 more Smart Citations

Review of pregnancy in Crohn’s disease and ulcerative colitis

Laube

Paramsothy

Leong

2021

Therap Adv Gastroenterol

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“…Children with one parent with IBD have a 2-13 times higher risk of IBD. An especially active disease is associated with adverse birth outcomes, including spontaneous abortion, decreased live birth rate, low birth weight, and newborns too small for the gestational age [4]. Other concerns do not correlate with any unequivocal scientific findings: miscarriage, death, and congenital abnormalities are not significantly increased in patients with IBD and their children in general [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Family planning with inflammatory bowel disease: the challenge of childlessness and parent concerns

et al. 2021

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Background In patients with inflammatory bowel disease (IBD), diagnosis is often established at the beginning of childbearing age. Accordingly, concerns about family planning and pregnancy (FPP) are common. Poor knowledge regarding FPP might contribute to increased childlessness in patients with IBD. Methods The Crohn’s and Colitis Pregnancy Knowledge Score (CCPKnow, 17 multiple-choice questions) was translated into German and then used for a web-based survey. Childlessness was analyzed with respect to socio-demographic and disease-related information, and the knowledge (CCPKnow) and concerns of IBD patients with children were compared to those of voluntarily childless (VC) and non-voluntarily childless (NVC) IBD patients. Results Childlessness was observed in 57.4 % of the 533 participants (90.6 % women, 63.0 % Crohn’s disease, 31.5 % ulcerative colitis, mean age 33.2 ± 8.6 years), voluntary childlessness in 9 %. The mean overall CCPKnow was adequate (9.38 ± 3.96). Poor knowledge was not associated with increased childlessness (CCPKnow of < 8 was found in 29.8 % of patients with children and 28.9 % of childless patients, p > 0.5). Instead, the patients’ education, medical advice, FPP-related concerns, impaired body image, and sexual dysfunction had a significant impact on childlessness. Frequent concerns included adverse effects of the patient’s medication on their child (36 % of the respondents), malformation (33 %), miscarriage (34.5 %), and the inheritability of IBD (57 %). Conclusions Factual knowledge does not reduce disease-related concerns or childlessness. Correct but possibly bothersome information on FPP might contribute to childlessness in patients with IBD. Our findings underline the need for qualified counseling of IBD patients regarding FPP by an experienced IBD physician.

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Autoimmune, Inflammatory, Atopic, Thyroid, and Psychiatric Outcomes of Offspring Born to Mothers With Alopecia Areata

Lee

Han

et al. 2023

JAMA Dermatol

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ImportanceAlopecia areata (AA) is associated with diverse autoimmune and psychiatric disorders. However, an investigation on the long-term outcomes for offspring born to mothers diagnosed with AA is lacking.ObjectiveTo investigate the risks for autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with AA.Design, Setting, and ParticipantsThis retrospective population-based birth cohort study used the linked birth registration database with the Nationwide Health Insurance Service database of Korea. The participants included all newborns born to mothers with 3 or more visits with International Classification of Diseases, Tenth Revision code of L63 and 1:10 birth year, sex, insurance, income, and location of residence–matched control offspring born to mothers without AA during the years from 2003 to 2015. The analysis was conducted from July 2022 to January 2023.ExposureMaternal AA.Main Outcomes and MeasuresThe occurrence of the following diseases was measured in newborns from birth to December 31, 2020: AA, alopecia totalis/universalis (AT/AU), vitiligo, psoriasis, inflammatory bowel disease, rheumatoid arthritis, atopic dermatitis, allergic rhinitis, asthma, hyperthyroidism, hypothyroidism, Graves disease, Hashimoto thyroiditis, attention-deficit hyperactivity disorder, mood disorder, and anxiety disorder. Multivariable Cox proportional hazard analyses were performed with the following covariates: birth year, age, insurance type, income level, location of residence, maternal age, mode of delivery, maternal history of atopic disorders, and autoimmune disorders.ResultsIn total, 67 364 offspring born to 46 352 mothers with AA and 673 640 controls born to 454 085 unaffected mothers were analyzed. The risk of AA (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.88-2.30), AT/AU (aHR, 1.57; 95% CI, 1.18-2.08), vitiligo (aHR, 1.47; 95% CI, 1.32-1.63), atopic disorders (aHR, 1.07; 95% CI, 1.06-1.09), hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25), and psychiatric disorders (aHR, 1.15; 95% CI, 1.11-1.20) was significantly increased in offspring born to mothers with AA. Among them, 5088 born to mothers with AT/AU were at much greater risk for the development of AT/AU (aHR, 2.98; 95% CI, 1.48-6.00) and psychiatric disorders (aHR, 1.27; 95% CI, 1.12-1.44).Conclusions and RelevanceIn this Korean retrospective population-based birth cohort study, maternal AA was associated with the development of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders in their offspring. Clinicians and parents need to be aware of the potential for these comorbidities to occur.

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Pregnancy outcomes in women with inflammatory bowel disease: a 10‐year nationwide population‐based cohort study

Cited by 55 publications

References 42 publications

Review of pregnancy in Crohn’s disease and ulcerative colitis

Review of pregnancy in Crohn’s disease and ulcerative colitis

Family planning with inflammatory bowel disease: the challenge of childlessness and parent concerns

Autoimmune, Inflammatory, Atopic, Thyroid, and Psychiatric Outcomes of Offspring Born to Mothers With Alopecia Areata

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