妊娠合并炎症性肠病的临床特点

doi:10.19723/j.issn.1671-167X.2024.02.009

Abstract

Abstract:

Objective: To analyze the clinical characteristics of patients with inflammatory bowel diseases (IBD) in pre-pregnancy, pregancy and loctation. Methods: The clinical data of pregnancy complicated with IBD in Department of Obstetrics and Gynecology of Peking University Third Hospital and deli-very from September 2011 to June 2022 were collected. The clinical characteristics of the patients were analyzed retrospectively. According to the state of diseases during pre-pregnancy, pregnancy and lactation, the patients were divided into active and remission group, and the two groups were compared interms of pre-pregnancy counseling, nutritional status, pregnancy and delivery complications, gestational week, mode of delivery, and neonatal outcome. Results: A total of 33 pregnant women with IBD were included in this study, of which 7 delivered a second child, for a total of 40 deliveries, with 36 natural pregnancies (90.0%) and 4 assisted reproductions (10.0%). Among the 40 cases, 21 cases (52.5%) were sustained in remission in pre-pregnancy, pregnancy and lactation, and 19 cases (47.5%) in disease activity, of which 8 cases (42.1%) were due to self-withdrawal of drugs or failure to take medicine regularly. Compared with the activity group, the disease remission group had a higher rate of pre-pregnancy counseling (57.1% vs. 15.8%, P=0.010), and higher levels of hemoglobin [(112.67±8.53) g/L vs. (102.84±5.23) g/L, P < 0.001], serum total protein [(66.58±6.34) g/L vs. (60.83±6.25) g/L, P=0.006], serum albumin [36.4 (35.1, 38.3) g/L vs. 34.3 (31.1, 35.6) g/L, P=0.006], serum calcium [(2.25±0.10) μmol/L vs. (2.13±0.15) μmol/L, P=0.004], but a lower incidence of gestational hypertensive disorders (0 vs. 31.6%, P=0.007). In 40 deliveries, there were 27 cases of vaginal delivery (67.5%), 13 cases of cesarean section (32.5%). The analysis of neonatal outcomes showed 38 full-term deliveries and 2 preterm deliveries; 1 case of macrosomia, 1 case of small-for-gestational-age, 1 case of low birth weight and 3 cases of birth defects. There were 10 newborns admitted to neonatal intensive care unit, including 4 cases of neonatal infections and 2 cases of neonatal jaundice. Conclusion: Pre-pregnancy counseling and evaluation of IBD patients are very important, and good pregnancy outcomes can be obtained through careful management during pregnancy in the most of the patients.

Key words: Inflammatory bowel diseases, Pregnancy outcome, Disease management, Pregnancy nutrition

CLC Number:

R714

Huichao MA,Jun LI,Yongqing WANG. Clinical characteristics of pregnancy complicated with inflammatory bowel disease[J].Journal of Peking University (Health Sciences), 2024, 56(2): 260-266.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Table 5

References 28

1	van der Giessen J , Huang VW , van der Woude CJ , et al. Modulatory effects of pregnancy on inflammatory bowel disease[J]. Clin Transl Gastroenterol, 2019, 10 (3): e00009. doi: 10.14309/ctg.0000000000000009
2	Bandoli G , Singh N , Strouse J , et al. Mediation of adverse pregnancy outcomes in autoimmune conditions by pregnancy complications: A mediation analysis of autoimmune conditions and adverse pregnancy outcomes[J]. Arthritis Care Res (Hoboken), 2020, 72 (2): 256- 264. doi: 10.1002/acr.24037
3	Torres J , Chaparro M , Julsgaard M , et al. European Crohn's and colitis guidelines on sexuality, fertility, pregnancy, and lactation[J]. J Crohns Colitis, 2023, 17 (1): 1- 27. doi: 10.1093/ecco-jcc/jjac115
4	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年, 北京)[J]. 中华消化杂志, 2018, 38 (5): 292- 311. doi: 10.3760/cma.j.issn.0254-1432.2018.05.002
5	谢幸, 孔北华, 段涛, 等. 妇产科学[M]. 9版北京: 人民卫生出版社, 2018.
6	中国营养学会. 中国妇女妊娠期体重监测与评价: T/CNSS 009—2021[S]. 北京: 中国营养学会, 2021: 1-4.
7	Laube R , Yau Y , Selinger CP , et al. Knowledge and attitudes towards pregnancy in females with inflammatory bowel disease: An international, multi-centre study[J]. J Crohns Colitis, 2020, 14 (9): 1248- 1255. doi: 10.1093/ecco-jcc/jjaa047
8	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病妊娠期管理的专家共识意见[J]. 中华炎性肠病杂志(中英文), 2019, 3 (4): 284- 295.
9	中华医学会消化病学分会炎症性肠病学组, 中华医学会肠外与肠内营养学分会胃肠病与营养协作组. 炎症性肠病营养支持治疗专家共识(第二版)[J]. 中华炎性肠病杂志(中英文), 2018, 2 (3): 154- 172.
10	Bell SJ , Flanagan EK . Updates in the management of inflammatory bowel disease during pregnancy[J]. Med J Aust, 2019, 210 (6): 276- 280. doi: 10.5694/mja2.50062
11	Zhang Y , Zhang L , Gao X , et al. Validation of the GLIM criteria for diagnosis of malnutrition and quality of life in patients with inflammatory bowel disease: A multicenter, prospective, observational study[J]. Clin Nutr, 2022, 41 (6): 1297- 1306. doi: 10.1016/j.clnu.2022.04.016
12	Ives CW , Sinkey R , Rajapreyar I , et al. Preeclampsia-patho-physiology and clinical presentations: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2020, 76 (14): 1690- 1702.
13	Tarar ZI , Farooq U , Zafar MU , et al. A national study of pregnancy- related maternal and fetal outcomes in women with inflammatory bowel disease[J]. Int J Colorectal Dis, 2022, 37 (7): 1535- 1543. doi: 10.1007/s00384-022-04185-9
14	Stevens GA , Finucane MM , De-Regil LM , et al. Global, regio-nal, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: A systematic analysis of population-representative data[J]. Lancet Glob Health, 2013, 1 (1): e16- e25. doi: 10.1016/S2214-109X(13)70001-9
15	赵思宇, 景文展, 刘珏, 等. 中国妇女2012—2016年妊娠期贫血患病状况的Meta分析[J]. 中华预防医学杂志, 2018, 52 (9): 951- 957. doi: 10.3760/cma.j.issn.0253-9624.2018.09.016
16	Abdul SA , West J , Ban L , et al. Adverse pregnancy outcomes among women with inflammatory bowel disease: A population-based study from England[J]. Inflamm Bowel Dis, 2016, 22 (7): 1621- 1630. doi: 10.1097/MIB.0000000000000802
17	Meyer A , Drouin J , Weill A , et al. Pregnancy in women with inflammatory bowel disease: A French nationwide study 2010-2018[J]. Aliment Pharmacol Ther, 2020, 52 (9): 1480- 1490.
18	Chaparro M , Kunovsky L , Aguas M , et al. Surgery due to inflammatory bowel disease during pregnancy: Mothers and offspring outcomes from an ECCO confer multicentre case series [scar study][J]. J Crohns Colitis, 2022, 16 (9): 1428- 1435.
19	国家卫生和计划生育委员会办公厅. 早产儿保健工作规范[J]. 中华围产医学杂志, 2017, 20 (6): 6.
20	Li HT , Hellerstein S , Zhou YB , et al. Trends in cesarean delivery rates in China, 2008-2018[J]. JAMA, 2020, 323 (1): 89- 91.
21	Burgess CJ , Schnier C , Wood R , et al. Prematurity, delivery method, and infant feeding type are not associated with paediatric-onset inflammatory bowel disease risk: A Scottish retrospective birth cohort study[J]. J Crohns Colitis, 2022, 16 (8): 1235- 1242.
22	Foulon A , Dupas JL , Sabbagh C , et al. Defining the most appropriate delivery mode in women with inflammatory bowel disease: A systematic review[J]. Inflamm Bowel Dis, 2017, 23 (5): 712- 720.
23	Lever G , Chipeta H , Glanville T , et al. Perineal outcomes after delivery in 179 mothers with inflammatory bowel disease compared to 31 258 controls: A single-centre cohort study[J]. J Crohns Colitis, 2022, 16 (3): 511- 514.
24	Burnett D , Brown MM , Otley A , et al. The association between caesarean section and inflammatory bowel disease in childhood and young adulthood: Findings from 2 retrospective cohort studies[J]. J Pediatr Gastroenterol Nutr, 2020, 71 (3): e84- e89.
25	Peyrin-Biroulet L , Panés J , Sandborn WJ , et al. Defining disease severity in inflammatory bowel diseases: Current and future directions[J]. Clin Gastroenterol Hepatol, 2016, 14 (3): 348- 354.
26	Kane S , Lemieux N . The role of breastfeeding in postpartum disease activity in women with inflammatory bowel disease[J]. Am J Gastroenterol, 2005, 100 (1): 102- 105.
27	Ananthakrishnan AN , Bernstein CN , Iliopoulos D , et al. Environmental triggers in IBD: A review of progress and evidence[J]. Nat Rev Gastroenterol Hepatol, 2018, 15 (1): 39- 49.
28	Gubatan J , Nielsen OH , Levitte S , et al. Biologics during pregnancy in women with inflammatory bowel disease and risk of infantile infections: A systematic review and meta-analysis[J]. Am J Gastroenterol, 2021, 116 (2): 243- 253.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 10

[1]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 135 -140 .
[2]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 188 -191 .
[3]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(5): 505 -515 .
[4]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 304 -309 .
[5]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 319 -322 .
[6]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 456 -458 .
[7]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 125 -128 .
[8]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 158 -161 .
[9]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(1): 109 -111 .
[10]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(6): 682 -686 .

Items	Data
Age of illness/years	27.18±4.42
Montreal classification of UC
E1	16 (48.49)
E2	7 (21.21)
E3	8 (24.24)
Montreal classification of CD
A2L3B3	1 (3.03)
A2L3B2	1 (3.03)
Family hereditary history
Yes	3 (9.09)
No	30 (90.91)
Smoking history
Yes	4 (12.12)
No	29 (87.88)
Previous extraintestinal manifestations
Yes	6 (18.18)
No	27 (81.82)
Bad history of pregnancy and birth
Yes	3 (3.03)
No	30 (96.97)

Items	Data
Age of childbirth/years	32.58±3.54
Course of IBD/years	4 (3, 8)
Pre-pregnancy counseling
Yes	15 (37.5)
No	25 (62.5)
Assisted reproduction
Yes	4 (10.0)
No	36 (90.0)
State of the disease before pregnancy
Remission period	33 (82.5)
Active period	7 (17.5)
Drug treatment before pregnancy
5-ASA (oral/topical/enema)	34 (85.0)
Glucocorticoids	0
Immunosuppressant	0
Biological preparation	2 (5.0)
Enteral nutrition or probiotics	7 (17.5)

Items	Remission group (n=21)	Active group (n=19)	Statistics	P
Pre-pregnancy counseling	12 (57.1)	3 (15.8)		0.010
Pre-pregnancy BMI/(kg/m²)	20.84±3.23	21.74±3.08	t=-0.892	0.378
Weight gain during pregnancy/kg	14.0 (10.0, 15.0)	15.0 (11.0, 16.5)	Z=1.346	0.187
Hemoglobin/(g/L)	112.67±8.53	102.84±5.23	t=4.434	＜0.001
Serum total protein/(g/L)	66.58±6.34	60.83±6.25	t=2.883	0.006
Serum albumin/(g/L)	36.4 (35.1, 38.3)	34.3 (31.1, 35.6)	Z=-2.723	0.006
Blood calcium/(μmol/L)	2.25±0.10	2.13±0.15	t=3.025	0.004

Items	Total (n=40)	Remission group (n=21)	Active group (n=19)	P
Premature rupture of membranes	5 (12.5)	3 (14.3)	2 (10.5)	＞0.999
Gestational diabetes mellitus	7 (17.5)	4 (19.0)	3 (15.8)	＞0.999
Hypertensive disorders of pregnancy	6 (15.0)	0	6 (31.6)	0.007
Fetal distress in uterus	4 (10.0)	2 (9.5)	2 (10.5)	＞0.999
Postpartum hemorrhage	6 (15.0)	5 (23.8)	1 (5.3)	0.186
Chorioamnionitis	2 (5.0)	0	2 (10.5)	0.219

Items	Remission group (n=21)	Active group (n=19)	Statistics	P
Average length of stay/d	4.0 (3.0, 6.0)	8.0 (4.0, 14.0)	Z=1.881	0.065
Gestational week of delivery	39.57 (38.71, 40.00)	39.18 (38.71, 39.86)	Z=-0.978	0.333
Mode of delivery			χ²=1.522	0.127
Vaginal delivery	16 (76.19)	11 (57.90)
Cesarean section	5 (23.81)	8 (42.10)
Neonatal condition
Body mass/g	3 460 (3 320, 3 630)	3 250 (2 930, 3 450)	Z=-1.924	0.054
Body length/cm	49.86±1.77	48.47±2.88	t=-1.743	0.088
Birth defect	2(9.52)	1 (5.26)		＞0.999
Admitted to NICU	3 (14.29)	7 (36.84)		0.148
Infection	1 (4.76)	3 (15.79)		0.331
Normal growth and development	21 (100)	18 (97.74)		0.475
Lactation condition			χ²=1.061	0.592
Breast-feeding	15 (71.43)	12 (63.16)
Mixed feeding	4 (19.05)	6 (31.58)
Artificial feeding	2 (9.52)	1 (5.26)

Clinical characteristics of pregnancy complicated with inflammatory bowel disease

RICH HTML

PDF (PC)

Abstract

Cite this article

share this article

Figures/Tables 5

References 28

Related Articles 5

Metrics

Comments

Recommended 10

[1]	Fang-ning YOU,Liang LUO,Xiang-jun LIU,Xue-wu ZHANG,Chun LI. Analysis of pregnancy outcomes, disease progression, and risk factors in patients with undifferentiated connective tissue disease [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1045-1052.
[2]	Xi-ya SUN,Yi-lu CHEN,Lin ZENG,Li-ying YAN,Jie QIAO,Rong LI,Xu ZHI. Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 167-173.
[3]	Ling-yi XU,Miao HUI,Shu-hong ZHU,Zhao YANG,Meng-rui LI,Hong-yu YANG,Xi-zi ZHENG,Ji-cheng LV,Li YANG. Chronic kidney disease in community: Current state for screening and management [J]. Journal of Peking University (Health Sciences), 2022, 54(5): 1056-封三.
[4]	ZHENG Xiao-Juan, DENG Xiao-Li, LIU Xiang-Yuan. Pregnancy outcome in 54 patients with antiphospholipid syndrome：a retrospective clinical study [J]. Journal of Peking University(Health Sciences), 2014, 46(2): 323-328.
[5]	REN Yun, YANG Shuo, YANG Rui, LI Rong, CHEN Xin-na, WANG Hai-yan, MA Cai-hong, LIU Ping, QIAO Jie. Comparison of gonadotropin releasing hormone agonist long protocol and gonadotropin releasing hormone antagonist protocol in infertile women [J]. Journal of Peking University(Health Sciences), 2013, 45(6): 877-881.