The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women

Pedersen, Natalia; Bortoli, A.; Ďuricová, Dana; Incà, Renata Dʼ; Panelli, M R; Gisbert, Javier P.; Zoli, Giorgio; López-Sanromán, Antonio; Castiglione, Fabiana; Riegler, G.; Annese, Vito; Gionchetti, Paolo; Prada, Alberto; Pont, E. Dal; Timmer, Antje; Felley, Christian; Shuhaibar, M.; Tsianos, Epameinondas V.; Dejaco, Clemens; Baert, F; Jess, Tine; Lebech, Morten; Hommes, Daniël W.; Munkholm, Pia

doi:10.1111/apt.12412

Cited by 162 publications

(109 citation statements)

References 42 publications

(55 reference statements)

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“…For many of these patients, disease activity during pregnancy requires effective management to maintain maternal health and ensure optimal fetal outcomes. Up to half of pregnant patients with rheumatic diseases and the majority of those with inflammatory bowel disease (IBD) experience active disease and need treatment 3, 4. High disease activity is associated with an increased risk of pregnancy complications and adverse outcomes, including preeclampsia, preterm delivery, low birth weight, small for gestational age, and fetal loss 5, 6, 7, 8, 9, 10, 11, 12, 13.…”

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confidence: 99%

Pregnancy Outcomes After Exposure to Certolizumab Pegol

Clowse

Scheuerle

Chambers

et al. 2018

Arthritis & Rheumatology

149

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ObjectiveAnti–tumor necrosis factor (anti‐TNF) medications are effective in controlling chronic inflammatory diseases, but information about their use and safety in pregnancy is limited. Consequently, anti‐TNF agents are often discontinued early in gestation. Certolizumab pegol (CZP), a PEGylated, Fc‐free anti‐TNF agent approved for the treatment of rheumatic diseases and/or Crohn's disease, has minimal to no active placental transfer. This analysis was undertaken to evaluate pregnancy outcomes in women receiving CZP, especially those exposed during early pregnancy.MethodsProspective and retrospective data on maternal CZP exposure were extracted from the UCB Pharma safety database through March 6, 2017. Analysis was limited to prospective reports to avoid potential bias associated with retrospective submissions. The numbers of live births, miscarriages, elective abortions, stillbirths, and major congenital malformations were ascertained.ResultsOf 1,137 prospectively reported pregnancies with maternal exposure to CZP, 528 (including 10 twin pregnancies) had 538 known outcomes: 459 live births (85.3%), 47 miscarriages (8.7%), 27 elective abortions (5.0%), and 5 stillbirths (0.9%). There were 8 major congenital malformations (1.7%) among the 459 infants. First trimester exposure occurred in 367 (81.2%) of 452 pregnancies resulting in 459 live births. Exposure during all 3 trimesters occurred in 201 (44.5%) of 452 pregnancies.ConclusionThis analysis represents the largest cohort of pregnant women exposed to an anti‐TNF agent for management of chronic inflammatory diseases. Analysis of pregnancy outcomes does not indicate a teratogenic effect of CZP, compared to the general population, nor an increased risk of fetal death. The data are reassuring for women of childbearing age considering treatment with CZP.

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confidence: 99%

Pregnancy Outcomes After Exposure to Certolizumab Pegol

Clowse

Scheuerle

Chambers

et al. 2018

Arthritis & Rheumatology

149

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“…In consultation with experts in the field, and the known risk of postpartum exacerbation, this was considered to be any hospitalisation before, during, or within the 6 months after the index birth where a diagnosis of UC or CD was recorded. 17 Births where the mother's first available record of diagnosis of IBD was >6 months after the birth were classified as no IBD at the time of birth.…”

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confidence: 99%

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Shand

Chen

Selby

et al. 2016

BJOG

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Objective To determine the prevalence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), in pregnant women and determine pregnancy and fetal/neonatal outcomes.Design Population-based cohort study.Setting New South Wales, Australia, 2001-11.Population A total of 630 742 women who delivered at ≥20 weeks of gestation.Methods Descriptive and multivariate regression analyses of perinatal data linked to hospital admission data. We compared birth outcomes of women with and without a documented diagnosis of IBD.Main outcome measures Caesarean section, severe maternal morbidity, preterm birth <37 weeks of gestation, planned preterm birth, small-for-gestational-age (birthweight <10th centile), perinatal mortality (stillbirth/neonatal death ≤28 days).Results In all, 1960 women (0.31%) with IBD, who had 2781 births (1183 UC, 1287 CD and 311 IBD-indeterminate). Women with IBD were more likely than women without IBD to have a caesarean section [41.5 versus 28.2%, adjusted risk ratio (aRR) 1.38, 95% CI 1.31-1.45], severe maternal morbidity (2.6 versus 1.6%, aRR 1.54, 95% CI 1.17-2.03), preterm birth (9.7 versus 6.6%, aRR 1.47, 95% CI 1.30-1.66), planned preterm birth (5.3 versus 2.9%, aRR 1.74, 95% CI 1.47-2.07), and their infants to be small-for-gestational-age (9.7 versus 9.5%, aRR 1.19, 95% CI 1.04-1.36). There was no evidence of a difference in perinatal mortality.Conclusion Pregnancy-associated IBD is more common than previously reported. Pregnancies complicated by IBD at or near the time of birth have significantly higher rates of adverse pregnancy outcomes than pregnancies of women without IBD.Keywords Crohn's disease, inflammatory bowel disease, population-based, pregnancy, ulcerative colitis.Tweetable abstract Increased rates preterm birth and caesarean section in women with inflammatory bowel disease.Please cite this paper as: Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes.

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“…In contrast, ulcerative colitis exacerbations are more likely to occur in pregnant patients (both during pregnancy and after delivery) than in non-pregnant patients. Relapse may occur most often during the first and second trimesters of pregnancy [9]. Overall, pregnancy has a positive effect on the course of IBD.…”

Section: Influence Of Pregnancy On the Course Of Inflammatory Bowel Dmentioning

confidence: 99%

“…71% of CD patients and 60% of UC patients remain in remission during the postpartum period, compared to 78% and 81% of patients in the control group, respectively. For CD patients, more than five years history of disease is a risk factor for a recurrence in the postpartum period [9]. After the pregnancy, function of J-Pouch remains unchanged [24].…”

Section: Postpartum Periodmentioning

confidence: 99%

Inflammatory bowel disease and pregnancy

et al. 2017

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Inflammatory bowel disease (IBD) comprising Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course. This article aims at improving pre-conception counseling of patients with inflammatory bowel disease.

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The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women

Abstract: SUMMARY BackgroundThe impact of pregnancy on the course of IBD is still controversial.

Cited by 162 publications

References 42 publications

Pregnancy Outcomes After Exposure to Certolizumab Pegol

Pregnancy Outcomes After Exposure to Certolizumab Pegol

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Inflammatory bowel disease and pregnancy

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