Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 260-266. doi: 10.19723/j.issn.1671-167X.2024.02.009

Previous Articles     Next Articles

Clinical characteristics of pregnancy complicated with inflammatory bowel disease

Huichao MA1,3,Jun LI2,Yongqing WANG1,*()   

  1. 1. Department of Obstetrics and Gynecology, Peking University Third Hospital; National Clinical Research Center for Obstetrics and Gynecology; Key Laboratory of Assisted Reproduction, Ministry of Education; Beijing Key Laboratory of Reproductive Endocrinolgy and Assisted Reproductive Technology, Beijing 100191, China
    2. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Obstetrics and Gynecology, Ningjin County Hospital of Hebei, Xingtai 055550, Hebei, China
  • Received:2022-12-03 Online:2024-04-18 Published:2024-04-10
  • Contact: Yongqing WANG E-mail:mddoctor@163.com
  • Supported by:
    the National Key Research and Development Program of China(2022YFC2703504)

RICH HTML

   

PDF (PC)

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

Table 1

Clinical characteristics of 33 patients with IBD before pregnancy"

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)

Table 2

General condition of 40 cases of pregnancy"

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)

Table 3

Pre-pregnancy counseling and nutritional status of IBD remission and active group"

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

Table 4

Complications of pregnancy and delivery in the IBD remission and active groups"

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

Table 5

Pregnancy outcome and lactation in patients with IBD"

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)
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.
[1] Xinyi LI, Jinxia ZHAO, Rong MU. Impact of aspirin use on pregnancy outcomes in patients with systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1074-1080.
[2] Wenqiong WANG, Yuke HOU, Chun LI, Xuewu ZHANG. Predictors of adverse pregnancy outcomes in patients with systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 599-603.
[3] Wen BIAN, Wenjun ZHOU, Tianchen WU, Peijing ZHU, Yinuo CHEN, Pengbo YUAN, Xueju WANG, Ying WANG, Yuan WEI, Yangyu ZHAO. Perinatal outcomes of single intrauterine fetal demise in monochorionic diamniotic twins [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 592-598.
[4] Shuhan YANG, Yixin LI, Haoliang CUI, Youxin WANG, Yuying WU, Mingyue WANG, Yifan YANG, Nur Enkar, Lei YANG, Hui WANG. Associations of metabolic dysfunction-associated steatotic liver disease and cardiometabolic risk factor abnormalities with adverse pregnancy outcomes [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 487-495.
[5] 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.
[6] 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.
[7] 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.
[8] 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.
[9] 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.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd