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Abdul Sultan, Alyshah and West, Joe and Ban, Lu and Humes, David and Tata, Laila J. and Fleming, Kate M. and Nelson-Piercy, Catherine and Card, Timothy R. (2016) Adverse pregnancy outcomes among women with inflammatory bowel disease: a population based study from England. Inflammatory Bowel Diseases, 22 (7). pp. 1621-1630. ISSN 1536-4844

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Abstract

Background: There is limited contemporary population based evidence on adverse birth outcomes and pregnancy related complications for women with inflammatory bowel disease (IBD). This study provides such estimates of these risks and assesses variation by IBD type and surgical interventions.

Methods: We calculated the proportion of pregnancies in women with and without IBD between 1997 and 2012 throughout England using linked primary (Clinical Practice Research Datalink-CPRD) and secondary care (Hospital Episode Statistics-HES) data. Risk of pregnancy related complications and adverse birth outcome in women with Crohn’s Disease-CD and Ulcerative Colitis-UC were compared to risks in women without IBD using odds ratios (OR).

Results: Of 364,363 singleton pregnancies resulting in live or stillbirths 1,969 (0.5%) were in women with IBD. Women with CD were more likely to have pre-term births (OR=1.42 95%CI;1.12-1.79), babies with low birth weights (OR=1.39;1.05-1.83) and postpartum haemorrhage (OR=1.27;1.04-1.55) whereas women with UC were only at increased risk of pre-term births with an absolute risk difference of <2.7%. These risks remained independent of caesarean section (CS). Prior surgery for IBD did not increase risk of adverse birth outcomes or pregnancy related complications compared to cases without surgery, however women with IBD were more likely to have an elective CS.

Conclusion: Women with CD, have increased risks of some specific pregnancy related complications and adverse birth outcomes which are independent of caesarean section, however the absolute risk differences are small indicating that most women with IBD will have an uncomplicated pregnancy.

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