The effects of pre- and post-pregnancy inflammatory bowel disease diagnosis on birth outcomes (original) (raw)
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Pregnancy and Delivery of Women with IBD
New Concepts in Inflammatory Bowel Disease
We provide a basic overview of inheritance, fertility and influence of IBD and pregnancy, therapy in pregnancy and childbirth options. A crucial factor for good results is the degree of inflammation at the time of conception and during pregnancy. If the disease is inactive, there is no decrease in fertility and no greater risk of deterioration of disease in pregnancy and pregnancy does not differ from the normal population. The opposite situation occurs if there is a pregnancy at the time of disease activity. Then, in up to 75% of pregnancy courses with big problems, fertility declines, inflammation also worsens and the risk of exacerbations increases during pregnancy. This aggravates the course of pregnancy and childbirth and has a negative effect on the fetus. Therefore, it is necessary to plan for a longer period of disease stabilization and continue chronic medication and not discontinue drugs for the fear of negative impact of medications on fetal development. Commonly used drugs such as aminosalicylates, corticosteroids, immunosuppressants and biological therapy appear to be safe and well tolerated during pregnancy. The method of delivery is different for each individual and depends on the form and location of the inflammation and the preceding operations.
Inflammatory Bowel Diseases
Background: Mothers with inflammatory bowel disease (IBD) have an overall risk of adverse pregnancy outcomes. Knowing that weight loss and malnutrition are common features in IBD, we introduced inadequate gestational weight gain (GWG) as a predictor of adverse pregnancy outcomes among IBD mothers in the Norwegian Mother and Child Cohort Study (MoBa). Methods: MoBa with 95200 mothers enrolled from 1999 to 2008, comprised 287 mothers with ulcerative colitis (UC) and 215 with Crohn's disease (CD). Demographics, IBD history and disease activity during pregnancy were ascertained. Inadequate GWG was based on The US Institute of Medicine (IOM) recommendations. The associations between IBD and inadequate GWG or adverse pregnancy outcomes, were explored, adjusted for diabetes, hypertension, smoking, maternal age, education and disease activity. Results: The associations between IBD and small for gestational age (SGA) and between CD and preterm birth did not sustain, when inadequate GWG was added in the models. CD (34.3%) and UC mothers (26.7%) were more frequently exposed to inadequate GWG compared to non-IBD mothers (19.4%) (OR = 2.02, 95% CI: 1.42, 2.86 and OR = 1.46, 95% CI: 1.04, 2.05, respectively). IBD mothers with inadequate GWG (exposed) had a twofold risk of SGA compared to exposed non-IBD mothers (adjusted OR = 1.93, 95% CI: 1.13, 3.29). Exposed CD and UC mothers had a several-fold increased risk of SGA compared to nonexposed IBD mothers (OR = 4.5, 95% CI: 1.3, 16.2, OR = 5.5, 95% CI: 1.6, 18.5). Disease activity was associated with lower GWG. Conclusion: Inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD.
Inflammatory bowel disease and preterm delivery
International Journal of Gynecology & Obstetrics, 2005
Objective: The present study investigates pregnancy outcome in women with IBD and examines the effect of pregnancy on the severity of IBD. Method: A casecontrol study comparing deliveries by mothers with IBD between January 1988 and January 2005 was performed. For every birth by a mother with IBD, four births by non-IBD mothers were randomly selected and adjusted for ethnicity and year of delivery. Result: During the study period there were 48 deliveries to patients with Crohn's disease and 79 deliveries to patients with ulcerative colitis. Higher rates of preterm delivery (b 37 weeks) were found among patients with IBD as compared to the controls (odds ratios (OR) = 2.2; 95% confidence interval (CI) = 1.3-3.8). This association remained significant after adjustment for labor induction and multiple gestations, using the Mantel-Haenszel technique (weighted OR = 2.1; 95% CI 1.3-3.5 and weighted OR = 2.0; 95% CI 1.2-3.5; P = 0.012; respectively). In addition, these patients had higher rates of fertility treatments (OR = 2.2; 95% CI = 1.1-4.4). Using a multivariate analysis, controlling for maternal age and fertility treatments, preterm delivery was seen to be significantly associated with IBD (adjusted OR = 2.0; 95% CI = 1.2-3.5). Perinatal outcomes, such as perinatal mortality, low Apgar scores, and congenital malformations, were comparable to the outcomes in the control group. Conclusion: Maternal IBD is an 0020-7292/$ -see front matter D
Progress in Nutrition, 2015
The Inflammatory Bowel Diseases are a group of inflammatory diseases characterized by the presence of chronic inflammation, in the absence of infectious etiology. The two most well-known diseases in this group are: Crohn’s disease (CD) and Ulcerative Colitis (UC). In cases where it is not possible to distinguish between CD and UC, it is called Indeterminate Colitis. Inflammatory Bowel Diseases (IBD) can affect women pregnant. The causes of IBD are unknown, and the clinical course of the disease is characterized by phases of activity and remission. UC is a chronic inflammation of the mucosa of the colon and involving predominantly the left colon and rectum. It is associated with presence of blood and mucus in the stool, diarrhea and anemia. Characteristically, CD involves entire gastrointestinal tract, from the mouth to the anus. In CD, the inflammatory infiltrate involves the entire intestinal wall. Clinically manifested by abdominal pain, diarrhea, loss of appetite and weight loss....
The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review
Cureus
Inflammatory bowel disease (IBD) is a constellation of devastating chronic inflammatory changes in the bowel, either involving the large or small bowel or part of both. As it is widely diagnosed in the fertile age group, this disorder can present itself, very commonly, during pregnancy and thus a better understanding of the disease can be an important factor to influence the maternal and fetal well-being. Medications are what is considered the first line in the management of this disease to control the symptoms or keep the disease in remission. In addition to this, the drugs used to keep the disease in remission can also cause significant adverse effects on the patient and the new nurturing life preparing itself for the outside world. What the fetus gets from the mother will stay for life with the child. We conducted an electronic literature review search which highlights the significance and impact of sustained remission of IBD and the cautious use of various drugs during pregnancy for that purpose. In addition to the influences already mentioned, It is evident that nutritional deficiencies can also prevail with the advancing disease, something to manage as a side note as well. These deficiencies can have a definite effect on the fetus and may cause developmental malformations. In order to avoid this process, a systemic and joint approach should be curtailed. This can reduce the adverse outcomes associated with this ailment during pregnancy.
Pregnancy and Inflammatory Bowel Disease: A Special Combination
Middle East journal of digestive diseases./Middle East journal of digestive diseases, 2023
doi 100 000 inhabitants, most frequently in women (58% of cases), with a female/male ratio of 1.39:1. The prevalence of CD was 17 per 100 000 inhabitants, and of UC was 113 per 100 000 inhabitants. 4 However, it is a population in which information about clinical and therapeutic phenotypes is still not well known, and data about women are even scarcer. 5 Women are affected by IBD during different stages of their lives, including reproductive life, pregnancy, and menopause, so the way the disease is managed in women of reproductive age can affect its course. 6 At least 50% of patients with IBD are diagnosed at age 35, and the disease most often affects women during their peak reproductive years. 7 Treatment and health maintenance strategies are very relevant. IBD poses a particular challenge during pregnancy because the health of the mother and fetus must be considered. For this reason, it is of utmost importance that the gastroenterologist and patients with IBD are aware of the effect of IBD on pregnancy, the effect of pregnancy on IBD, and the effect of IBD medications on the fetus and on pregnancy outcomes. 8 Taking into account the importance of the subject in daily clinical practice, it was decided to conduct the following review http://mejdd.org
A meta-analysis on the influence of inflammatory bowel disease on pregnancy
Gut, 2007
Background: Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. Aim: To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. Design: The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. Patients and setting: A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. Results: For women with IBD, there was a 1.87-fold increase in incidence of prematurity (,37 weeks gestation; 95% CI 1.52 to 2.31; p,0.001) compared with controls. The incidence of low birth weight (,2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p,0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p,0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p,0.001). Conclusion: The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.
Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management
World journal of gastrointestinal pharmacology and therapeutics, 2015
Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pre...