Amy Yu1, Sonia Friedman2, Ashwin N Ananthakrishnan1,3. 1. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. 2. Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA. 3. Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: The postpartum period is marked by physiological and psychological stresses that may impact activity in inflammatory bowel disease. The predictors and outcomes of disease activity during this period have not been well characterized. METHODS: We performed a retrospective review of inflammatory bowel disease patients who underwent successful pregnancy and live birth at 2 referral institutions. Data on patient and disease factors including disease activity before and during pregnancy were abstracted from the medical records. We noted whether therapy was dose-reduced or stopped during pregnancy at each trimester and after delivery. Multivariable logistic regression of independent predictors of postpartum flare was performed, adjusting for relevant covariates. RESULTS: We identified a total of 206 eligible women (mean age, 33.2 years). Of these, 97 (47%) had a diagnosis of Crohn's disease, whereas the remainder had ulcerative colitis. Nearly half the women delivered vaginally (53%), and the rest delivered by Caesarean section (47%). In the entire cohort, 65 (31.6%) experienced a postpartum flare within the year after delivery. In multivariable analysis, development of a postpartum flare was predicted by disease activity during the third trimester (odds ratio [OR], 6.27; 95% confidence interval [CI], 2.81-17.27), therapy de-escalation during pregnancy (OR, 3.00; 95% CI, 1.03-8.68), and therapy de-escalation after pregnancy (OR, 4.43; 95% CI, 1.55-12.65). Postpartum disease flare was not related to disease type, duration of disease, or mode of childbirth. CONCLUSIONS: One-third of women with inflammatory bowel disease may experience disease flare during the postpartum year. Continued optimization of therapy before, during, and after pregnancy is essential to prevent this morbidity.
BACKGROUND: The postpartum period is marked by physiological and psychological stresses that may impact activity in inflammatory bowel disease. The predictors and outcomes of disease activity during this period have not been well characterized. METHODS: We performed a retrospective review of inflammatory bowel diseasepatients who underwent successful pregnancy and live birth at 2 referral institutions. Data on patient and disease factors including disease activity before and during pregnancy were abstracted from the medical records. We noted whether therapy was dose-reduced or stopped during pregnancy at each trimester and after delivery. Multivariable logistic regression of independent predictors of postpartum flare was performed, adjusting for relevant covariates. RESULTS: We identified a total of 206 eligible women (mean age, 33.2 years). Of these, 97 (47%) had a diagnosis of Crohn's disease, whereas the remainder had ulcerative colitis. Nearly half the women delivered vaginally (53%), and the rest delivered by Caesarean section (47%). In the entire cohort, 65 (31.6%) experienced a postpartum flare within the year after delivery. In multivariable analysis, development of a postpartum flare was predicted by disease activity during the third trimester (odds ratio [OR], 6.27; 95% confidence interval [CI], 2.81-17.27), therapy de-escalation during pregnancy (OR, 3.00; 95% CI, 1.03-8.68), and therapy de-escalation after pregnancy (OR, 4.43; 95% CI, 1.55-12.65). Postpartum disease flare was not related to disease type, duration of disease, or mode of childbirth. CONCLUSIONS: One-third of women with inflammatory bowel disease may experience disease flare during the postpartum year. Continued optimization of therapy before, during, and after pregnancy is essential to prevent this morbidity.
Authors: Rebecca Matro; Christopher F Martin; Douglas Wolf; Samir A Shah; Uma Mahadevan Journal: Gastroenterology Date: 2018-05-30 Impact factor: 22.682
Authors: Deepa Reddy; Seamus J Murphy; Sunanda V Kane; Daniel H Present; Asher A Kornbluth Journal: Am J Gastroenterol Date: 2008-04-16 Impact factor: 10.864
Authors: Christian P Selinger; Jayne Eaden; Warwick Selby; D Brian Jones; Peter Katelaris; Grace Chapman; Charles McDondald; John McLaughlin; Rupert W L Leong; Simon Lal Journal: J Crohns Colitis Date: 2012-10-02 Impact factor: 9.071
Authors: Michael D Kappelman; Sheryl L Rifas-Shiman; Ken Kleinman; Dan Ollendorf; Athos Bousvaros; Richard J Grand; Jonathan A Finkelstein Journal: Clin Gastroenterol Hepatol Date: 2007-09-29 Impact factor: 11.382