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Pregnancy and Pregnancy Outcomes in Women PowerPoint Presentation

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Published on : Dec 06, 2013
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Slide 1 - Pregnancy and Pregnancy Outcomes in Women With IBD
Slide 2 - Effects of IBD on Pregnancy Outcomes Preterm birth  risk in both UC and CD1,2,5 4 of 5 studies: no major impact on risk of congenital abnormalities1-5 Significant  in risk of low birth weight2-5  risk of maternal/delivery complications5 1Baird DD, et al. Gastroenterology. 1990;99:987-994. 2Dominitz JA, et al. Am J Gastroenterol. 2002;97:641-648. 3Porter RJ, Stirrat GM. Br J Obstet Gynaecol. 1986;93:1124-1131. 4Fonager K, et al. Am J Gastroenterol. 1998;93:2426-2430.4Mahadevan U, et al. Gastroenterol. 2007;133:1106-1112
Slide 3 - Meta-analysis 12 studies N= 3907 (CD 1952, UC 1113) vs. 320, 531 Prematurity OR = 1.87 (1.52-2.31) p<0.001 LBW OR = 2.10 (1.38-3.19) , p<0.001 C-section OR = 1.50 (1.26-1.79) p <0.001 Congen Abnorm. = 2.37 (1.47-3.82) p <0.001 4 studies reported on the incidence IBD vs. controls, no difference UC vs. controls in two studies (Larzilliere 1998, Dominitz) Cornish Gut 2006;0:1-8.
Slide 4 - Effect of Pregnancy on UC: Disease Activity at Conception Miller JP. J R Soc Med. 1986;79:221-225. Inactive Active NoRelapse Relapse WorsenedActivity Continued Activity DecreasedActivity 0 n=528 n=227 66 34 45 24 27 80 70 60 50 40 30 20 10 Percent
Slide 5 - 32 Effect of Pregnancy on CD: Disease Activity at Conception Miller JP. J R Soc Med. 1986;79:221-225. Inactive Active NoRelapse Relapse WorsenedActivity Continued Activity DecreasedActivity 0 n=186 n=93 73 27 33 34 80 70 60 50 40 30 20 10 Percent
Slide 6 - Disease activity during pregnancy in women with IBD Majority of patients have inactive to mild disease during pregnancy Mahadevan U, et al. Gastroenterol. 2007;133:1106-1112 Trimester Percentage of patients Disease activity in Crohn’s disease Disease activity in ulcerative colitis
Slide 7 - Effect of Pregnancy on IBD: Maternal-Fetal HLA Disparity Prepartum disease activity significantly predicts disease activity during pregnancy (P=.008) In single-locus disparity, no significant difference between DR and DQ prepartum, during trimesters 1-3, or postpartum Disparity at both DR and DQ loci significantly predicts disease activity during pregnancy (P=.001) Maternal immune response to paternal HLA antigens may play role in pregnancy-induced remission of IBD Kane S, et al. Gastroenterology. 1998;114:A1006. Abstract G4121.
Slide 8 - Concerns Regarding Pregnancy and Delivery What is the effect of pregnancy on pouch function before and after delivery? Should the woman deliver vaginally or have cesarean section? Are there unique concerns if cesarean section is performed?
Slide 9 - Delivery Mode and Perineal Injury Study indicates that more women with IBD have cesarean sections1 Vaginal delivery is usually safe for women with inactive perianal symptoms1 1Ilnyckyji A, et al. Am J Gastroenterol. 1999;94:3274-3278.
Slide 10 - Pouch Function During and After Pregnancy 10 vaginal deliveries, 6 cesarean sections No pouch complications 8.1 bowel movements/day during pregnancy vs 6.5/day postpartum 3 women had incontinence during pregnancy, 1 frequent and 2 mild 1 woman had nighttime incontinencepostpartum Scott HJ, et al. Int J Colorectal Dis. 1996;11:84-87.
Slide 11 - Pregnancy, Delivery, and Pouch Function After IPAA in UC Questionnaires sent to women with IPAA for UC Results 49 deliveries for 29 women (25 vaginal, 24 c-sections) 6 pouch-related complications (2 during pregnancy; 4 postpartum)  stool frequency and incontinence during pregnancy 83% regained prepregnancy function; 17% had some permanent pouch function deterioration not related to delivery method Delivery method did not affect incontinence, stool frequency Conclusion: Pregnancy is safe for women with IPAA Ravid A, et al. Dis Colon Rectum. 2002;45:1283-1288.
Slide 12 - IBD in Pregnancy: Summary Pregnancy outcomes best if patient in remission at time of conception, though even patients in remission can have higher rates of adverse outcomes compared to the general population IBD increases the risk of preterm birth and low birth weight and maternal complications No significant increase in risk of congenital abnormalities Women with IBD have a higher rate of cesarean sections Pregnancy may not increase the risk of relapse or significantly increase disease activit