The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Background Patients with inflammatory bowel disease (IBD) may be at increased risk of adverse neonatal outcomes. The aim of this study was to determine pooled incidences and risk factors for these outcomes. Methods Medline, Embase, and Cochrane Library were searched through May 2019 for studies reporting adverse neonatal outcomes in IBD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results The pooled incidence of preterm birth, low birth weight, congenital anomalies, and infants transferred to the neonatal intensive care unit was 8.6% (95% CI, 7.0%–10.1%), 8.9% (95% CI, 7.3%–10.5%), 2.1% (95% CI, 1.6%–2.6%), and 4.9% (95% CI, 2.9%–6.9), respectively. Compared with healthy controls, patients with IBD were more likely to deliver infants with low birth weight (<2500 grams; OR, 2.78; 95% CI, 1.16–6.66) and infants admitted to the intensive care unit (OR, 3.33; 95% CI, 1.83–6.05). Patients with Crohn’s disease had an increased incidence of congenital anomalies (OR, 3.03; 95% CI, 1.43–6.42). Among IBD patients, active disease was associated with increased incidence of preterm birth (OR, 2.06; 95% CI, 1.21–3.51), low birth weight (OR, 2.96; 95% CI, 1.54–5.70), and small for gestational age (OR, 2.62; 95% CI, 1.18–5.83). Antitumor necrosis factor (anti-TNF) use during pregnancy was associated with an increased incidence of neonatal intensive care unit admission (OR, 2.42; 95% CI, 1.31–4.45) and low birth weight (OR, 1.54; 95% CI, 1.01–2.35). Conclusions Patients with IBD, particularly with active disease or requiring anti-TNF therapy, may be at increased risk of developing adverse neonatal outcomes.