Prevalence and factors associated with inflammatory bowel disease (IBD) activity during pregnancy: updated data from the Dumbo registry

Abstract

Background IBD remission is key for pregnancy outcomes. Previous studies have suggested an IBD relapse risk of approximately 30% in patients in remission at conception, but this could be influenced by disease control in the periconceptional period and the discontinuation of treatments for IBD during pregnancy.

Aim To provide updated data on the incidence of disease relapse during pregnancy in IBD patients and to identify predictive factors of relapse.

Methods Pregnant patients with IBD from DUMBO registry were included. DUMBO is a prospective, observational, and multicentre registry, endorsed by GETECCU, which enrols pregnant women with IBD over 5 years in 70 centres in Spain. Study protocol is summarized in figure 1a. Relapse was defined based on the Crohn’s Disease Activity Index and the Partial Mayo Score in Crohn’s disease (CD) and ulcerative colitis (UC), respectively. Only patients in clinical remission at conception were considered for the relapse risk analysis (by Cox-regression).

Results Overall, 993 patients were available in DUMBO registry, 38 (4%) with active disease at conception. 961 patients gave birth (97% singleton), 0.4% had an abortion, 2.3% had miscarriages and 0.3% had a stillbirth. The probability of having active disease at each trimester was higher in patients with active disease at conception (table 1a). Seven patients underwent surgery due to IBD during pregnancy (4 abdominal and 3 perianal surgery); all of them were in remission at conception. A total of 112 out of 868 (12.9%) patients in remission at conception relapsed throughout pregnancy or puerperium (table 1b). The proportion of patients who discontinued treatment during pregnancy, with the exception of mesalamine, was similar between relapsers and non-relapsers (table 1c). Having UC (vs. CD) (Hazard ratio = 3.48, 95% confidence interval = 2.36–5.30) and higher C-reactive protein levels at conception (mg/dL) (Hazard ratio = 1.11, 95% confidence interval = 1.04–1.19) were the only variables associated with the risk of relapse.

Conclusion Patients with active disease at conception had a higher risk of remaining active during pregnancy, whereas those who conceived in remission showed a lower risk of relapse than previously reported. Relapse was three times more frequent in UC than in CD. As serious complications, including the need for surgeries, may arise even in patients who enter pregnancy in remission, close monitoring of IBD throughout pregnancy is warranted.