Is aspirin use associated with disease flare in pregnant women with inflammatory bowel disease?

IntroductionMedical therapy to maintain disease remission is important in pregnant women with inflammatory bowel disease (IBD), as disease flares can predispose adverse materno-fetal outcomes. However, women with IBD are more concerned about medication exposure on their newborn during pregnancy, and often discontinue their medications. Objectives and ApproachWe assessed the rate of disease flare on medication adherence pattern during pregnancy for women with IBD. Validated case definition was used to identify women with IBD from the Albertan’s hospitalization, emergency room, and physician claims databases (2010-2016). Pharmaceutical Information Network provided the dispensed medications. Adherence to medication was defined by medical possession ratio (MPR)≥0.8. Women with two consecutive prescriptions and MPR≥0.8 during pre-conception were included. Disease flare was defined by ≥1 hospitalization or emergency visit for IBD, or ≥1 prescription for steroids/rectal therapy. Chi-square tests and log binomial regression were used; covariates included age, drug class, and IBD subtypes. ResultsOf the 370 women identified with IBD, 170 (45.9%) women were adherent to maintenance IBD medications in the one year prior to pregnancy. During pregnancy, 47 (27.6%; 95% CI: 21.4% to 34.9%) women, who demonstrated adherence in the pre-conception period, discontinued or were not adherent to their IBD medications, and 67 (39.4%; 95% CI: 32.3% to 47.0%) women had a disease flare during pregnancy. There was no significant difference between adherence to medication during pregnancy and a disease flare during pregnancy (p=0.38). In comparing women who were not adherent or discontinued their medication to those that were adherent, the adjusted relative risk ratio for a disease flare during pregnancy was 1.22 (95% CI: 0.81 to 2.04). Conclusion/ImplicationsThe rate of disease flare during pregnancy was not significantly different for women with IBD that were adherent or not-adherent to their IBD medications during pregnancy. Future analysis will assess the rate of disease flare on medication adherence pattern prior to pregnancy.

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Su1184 - Evaluation of Fecal Lactoferrin and Calprotectin Levels in Healthy Pregnant Women as a Reference for Detecting Inflammatory Bowel Disease

Gastroenterology ◽

10.1016/s0016-5085(18)31884-5 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-497 ◽

Cited By ~ 1

Author(s):

James M. Gray ◽

Allison Durica ◽

Kristin Knight ◽

Megan Lord ◽

Lauren Irby ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Fecal Lactoferrin ◽

Inflammatory Bowel

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Vaginal microbiota in pregnant women with inflammatory rheumatic and inflammatory bowel disease: A matched case‐control study

Mycoses ◽

10.1111/myc.13288 ◽

2021 ◽

Author(s):

Klara Rosta ◽

Antonia Mazzucato‐Puchner ◽

Herbert Kiss ◽

Veronika Malik ◽

Peter Mandl ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Case Control Study ◽

Case Control ◽

Vaginal Microbiota ◽

Inflammatory Bowel ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

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Pregnancy outcomes in women with inflammatory bowel disease following exposure to thiopurines and antitumor necrosis factor drugs

Human & Experimental Toxicology ◽

10.1177/0960327114550882 ◽

2014 ◽

Vol 34 (5) ◽

pp. 445-459 ◽

Cited By ~ 26

Author(s):

S Mozaffari ◽

AH Abdolghaffari ◽

S Nikfar ◽

M Abdollahi

Keyword(s):

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Pregnancy Outcomes ◽

Congenital Abnormalities ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Inflammatory Bowel ◽

Adverse Pregnancy ◽

Necrosis Factor

Several studies have indicated the harmful effect of flare-up periods in pregnant women with inflammatory bowel disease (IBD) on their newborns. Therefore, an effective and safe medical treatment during pregnancy is of great concern in IBD patients. The aim of this study was to perform a meta-analysis on the outcomes of thiopurines use and a systematic review of antitumor necrosis factor (anti-TNF) drugs used during pregnancy in women with IBD. The results of cohorts evaluating the safety of anti-TNF drugs during pregnancy up to July 2013 were collected and analyzed. In the meta-analysis, a total of 312 pregnant women with IBD who used thiopurines were compared with 1149 controls (women with IBD who were not treated with any medication and women who were exposed to drugs other than thiopurines) to evaluate the drug effect on different pregnancy outcomes, including prematurity, low birth weight, congenital abnormalities, spontaneous abortion, and neonatal adverse outcomes. Results of statistical analysis demonstrated that congenital abnormalities were increased significantly in thiopurine-exposed group in comparison with control group who did not receive any medicine for IBD treatment. The summary odds ratio was 2.95 with 95% confidence interval = 1.03–8.43 ( p = 0.04). We observed no significant differences in occurrence of other adverse pregnancy outcomes between compared groups. The results of cohorts evaluated the safety of anti-TNF drugs during pregnancy demonstrated no increase in occurrence of adverse pregnancy outcomes in comparison with controls except for the significant decrease in gestational age of newborns of drug-exposed mothers in one trial. In conclusion, a benefit–risk ratio should be considered in prescribing or continuing medicinal therapy during pregnancy of IBD patients.

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Socio-anamnestic and clinical analysis of pregnant women with ulcerative colitis

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(1)-12 ◽

2021 ◽

Vol 25 (1) ◽

pp. 65-69

Author(s):

I. V. Oleksiienko

Keyword(s):

Ulcerative Colitis ◽

Health Care ◽

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Clinical Analysis ◽

Chronic Inflammatory Bowel Disease ◽

Care Providers ◽

History Of ◽

Inflammatory Bowel

Annotation. At the turn of the 21st century, chronic inflammatory bowel disease (CIBD) has become a global disease with accelerating morbidity in industrialized countries with a prevalence exceeding 0.3%. These data underscore the need for research into the prevention of inflammatory bowel disease and innovations in health care systems to manage this complex and costly disease. The information from a personal anamnesis of 40 women patients with ulcerative colitis (clinical group (main). In the second group (control), 30 practically healthy pregnant women with a physiological course of gestation were included, which did not have in their history of inflammatory intestinal diseases. Statistical processing of research results was performed using the software package Statistica 6.0. The arithmetic mean (M) and the standard deviation error (± m) (p<0.05) were determined, as well as the odds ratio (OR), confidence interval (CI) at p=95%. It was found that for women with ulcerative colitis is characterized by the presence of a history of obstetric pathology, such as: spontaneous miscarriage of OR 3.33, 95% CI [1.06-10.53], p=0.04 and blood secretions of OR 3.0, 95% CI [1.00-8.98], p=0.0496; among extragenital pathology in the anamnesis: children's infectious diseases of OR 4.85, 95% CI [1.25-18.85], p=0.02, chronic bronchitis of OR 7.54, 95% CI [1,56-36, 41], p=0.01, varicose veins OR 4.33, 95% CI [1.11-16.95], p=0.035, chronic gastritis OR 6.0, 95% CI [1,23-29, 31], p=0.03, anemia of OR 15.0, 95% CI [4.53-49.68], p<0.0001, allergy history of OR 6.65, 95% CI [1.73-25.60], p=0.006; among gynecological complications – premenstrual syndrome OR 6.0, 95% CI [1.55-23.15], p=0.009, algomenorrhea OR 8.14, 95% CI [2.12-31.24], p=0.002 , salpingo-oophoritis, OR 7.54, 95% CI [1.56-36.41], p=0.01. Because CIBD during pregnancy is associated with an increased risk of adverse effects on the mother and fetus, information on socio-anamnestic and clinical analysis of pregnant women with ulcerative colitis will be useful to health care providers in making decisions about CIBD during pregnancy.

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P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.263 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S223-S224

Author(s):

A Viola ◽

F Giambò ◽

M F Chiappetta ◽

G Costantino ◽

S Pallio ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Secondary Outcome ◽

Reference Period ◽

Disease Flare ◽

Face To Face ◽

Risk Of Disease ◽

Inflammatory Bowel ◽

Group 2 ◽

The Impact

Abstract Background The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC). Methods IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019. Results A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p<0.001) both. Treatment delays or transitory stops were more frequent in EV (p<0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p < 0.001). Conclusion Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.

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423 DYNAMICS OF INTESTINAL INFLAMMATION AND MICROBIAL DYSBIOSIS IN PREGNANT WOMEN WITH INFLAMMATORY BOWEL DISEASE AND THEIR INFANTS

Gastroenterology ◽

10.1016/s0016-5085(20)30888-x ◽

2020 ◽

Vol 158 (6) ◽

pp. S-83-S-84

Author(s):

Eun Soo Kim ◽

Leonid Tarassishin ◽

Caroline Eisele ◽

Amélie Barré ◽

Anne Thjømøe ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Intestinal Inflammation ◽

Microbial Dysbiosis ◽

Inflammatory Bowel

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Incidence and Predictors of Flares in the Postpartum Year Among Women With Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz313 ◽

2020 ◽

Vol 26 (12) ◽

pp. 1926-1932 ◽

Cited By ~ 2

Author(s):

Amy Yu ◽

Sonia Friedman ◽

Ashwin N Ananthakrishnan

Keyword(s):

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Multivariable Analysis ◽

Third Trimester ◽

Disease Flare ◽

Entire Cohort ◽

Duration Of Disease ◽

Inflammatory Bowel ◽

Relevant Covariates

Abstract Background The postpartum period is marked by physiological and psychological stresses that may impact activity in inflammatory bowel disease. The predictors and outcomes of disease activity during this period have not been well characterized. Methods We performed a retrospective review of inflammatory bowel disease patients who underwent successful pregnancy and live birth at 2 referral institutions. Data on patient and disease factors including disease activity before and during pregnancy were abstracted from the medical records. We noted whether therapy was dose-reduced or stopped during pregnancy at each trimester and after delivery. Multivariable logistic regression of independent predictors of postpartum flare was performed, adjusting for relevant covariates. Results We identified a total of 206 eligible women (mean age, 33.2 years). Of these, 97 (47%) had a diagnosis of Crohn’s disease, whereas the remainder had ulcerative colitis. Nearly half the women delivered vaginally (53%), and the rest delivered by Caesarean section (47%). In the entire cohort, 65 (31.6%) experienced a postpartum flare within the year after delivery. In multivariable analysis, development of a postpartum flare was predicted by disease activity during the third trimester (odds ratio [OR], 6.27; 95% confidence interval [CI], 2.81–17.27), therapy de-escalation during pregnancy (OR, 3.00; 95% CI, 1.03–8.68), and therapy de-escalation after pregnancy (OR, 4.43; 95% CI, 1.55–12.65). Postpartum disease flare was not related to disease type, duration of disease, or mode of childbirth. Conclusions One-third of women with inflammatory bowel disease may experience disease flare during the postpartum year. Continued optimization of therapy before, during, and after pregnancy is essential to prevent this morbidity.

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