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Clinical management and outcomes of pregnant women with inflammatory bowel diseases

Year 2020, Volume: 2 Issue: 4, 122 - 127, 28.12.2020
https://doi.org/10.46969/ezh.751082

Abstract

Objectives: Inflammatory Bowel Diseases (IBD); Ulcerative colitis (UC) and Crohn's disease (CD) are chronic pathologies affecting young adults. Pregnancy and IBD are multidimensional and could be affected by many variables. In this study, we aimed to present our patients with inflammatory bowel diseases and their clinical management.
Materials and methods: Pregnants with inflammatory bowel diseases were retrospectively evaluated. Pregnant women with inflammatory bowel disease were grouped as those with Crohn's disease ( CD ) and ulcerative colitis ( UC ). A total of nine cases were included in the study.
Results: The mean age of the patients was 28.5 ± 4.9 years. The mean gravida number was 2.6 ± 1, and the mean parity number was 1.55 ± 1.13. Six patients with inflammatory bowel diseases had UC, and three patients had CD. Two patients were newly diagnosed and seven patients had a history of inflammatory bowel disease. The mean gestational week of the 8 patients was 34.2 ± 4.55 weeks. The mean first and fifth minute APGAR scores were 7.6 ± 0.91 and 8.87 ± 0.83, respectively. The mean birth weight of all of the patients was 2530 ± 956.
Conclusions: Inflammatory bowel disease affects a large group of women at childbearing age. Pregnancy, maternal and fetal outcomes are widely affected by disease activity. Becoming pregnant can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Controlling IBD is the main obstetrical factor for prognosis.

References

  • Huang V, Leung Y, Nguyen GC, Seow CH. Management of Inflammatory Bowel Disease in Pregnancy: A Practical Approach to New Guidelines. Can J Gastroenterol Hepatol 2016; 2016:9513742.
  • Habal FM, Kapila V. Inflammatory bowel disease and pregnancy: evidence, uncertainty and patient decision-making. Can J Gastroenterol 2009; 23:49-53.
  • Dağli Ü. Turkish Inflammatory Bowel Disease Society recommendations on selected topics of ulcerative colitis. Turk J Gastroenterol 2012; 23 Suppl 2:1-2.
  • Yang DH, Keum B, Jeen YT. Capsule Endoscopy for Crohn's Disease: Current Status of Diagnosis and Management. Gastroenterol Res Pract 2016; 2016:8236367.
  • Rogers RG, Katz VL. Course of Crohn's disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol 1995; 12:262-264.
  • O'Toole A, Nwanne O, Tomlinson T. Inflammatory Bowel Disease Increases Risk of Adverse Pregnancy Outcomes: A Meta-Analysis. Dig Dis Sci 2015; 60:2750-2761.
  • Mountifield R, Bampton P, Prosser R, Muller K, Andrews JM. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2009; 15:720-725.
  • Hashash JG, Kane S. Pregnancy and Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2015; 11:96-102.
  • Padhan RK, Kedia S, Garg SK, Bopanna S, Mouli VP, Dhingra R, et al. Long-Term Disease Course and Pregnancy Outcomes in Women with Inflammatory Bowel Disease: An Indian Cohort Study. Dig Dis Sci 2017; 62:2054-2062.
  • Bar-Gil Shitrit A, Grisaru-Granovsky S, Ben Ya'acov A, Goldin E. Management of Inflammatory Bowel Disease During Pregnancy. Dig Dis Sci 2016; 61:2194-2204.
  • Mahadevan U, Cucchiara S, Hyams JS, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol 2011; 106:214-223; quiz 24.
  • Nguyen GC, Seow CH, Maxwell C, et al. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology 2016; 150:734-757.e1.
  • Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes. BJOG 2016; 123:1862-1870.
  • Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis 2011; 17:795-801.
  • Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology 2007; 133:1106-1112.
  • Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med 2000; 160:610-619.
  • Leroy C, Rigot JM, Leroy M, et al. Immunosuppressive drugs and fertility. Orphanet J Rare Dis 2015; 10:136.
  • Pervez H, Usman N, Ahmed MM, Hashmi MS. The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review. Cureus 2019; 11:e5648.
  • Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn's disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology 2000; 47:1595-1598.
  • Ban L, Tata LJ, Humes DJ, Fiaschi L, Card T. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study. Aliment Pharmacol Ther 2015; 42:855-866.
  • Lavie I, Lavie M, Doyev R, Fouks Y, Azem F, Yogev Y. Pregnancy outcomes in women with inflammatory bowel disease who successfully conceived via assisted reproduction technique. Arch Gynecol Obstet 2020; 302:611-618.
  • Czymek R, Limmer S, Kleemann M, et al. Crohn's disease-a chameleon during pregnancy. Langenbecks Arch Surg 2009; 394:517-527.
  • van der Woude CJ, Ardizzone S, Bengtson MB, et al. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9:107-124.
  • Kalkan İ H, Dağli Ü. Safety of drugs used in cases with ulcerative colitis during pregnancy and lactation. Turk J Gastroenterol 2012; 23 Suppl 2:48-56.
  • A SPECIAL MEETING REVIEW EDITION: Highlights in Crohn's Disease and Ulcerative Colitis: Digestive Disease Week 2012 May 19-22, 2012 • San Diego, CaliforniaSpecial Reporting on:• Safety and Efficacy of Subcutaneous Golimumab Induction Therapy in Patients with Moderately to Severely Active UC: PURSUIT-SC• The Future of IBD Therapy: Individualized and Optimized Therapy and Novel Mechanisms• Infliximab Concentration and Clinical Outcome in Patients with UC• Vedolizumab Induction Therapy for UC: Results of GEMINI I, A Randomized, Placebo-Controlled, Double-Blind, Multicenter, Phase III Trial• Novel Infliximab and Antibody-to-lnfliximab Assays Are Predictive of Disease Activity in Patients with CD• Accelerated Step-Care Therapy with Early Azathioprine Versus Conventional Step-Care Therapy in CD• PIANO: A 1,000-Patient Prospective Registry of Pregnancy Outcomes in Women with IBD Exposed to Immunomodulators and Biologic TherapyPLUS Meeting Abstract Summaries With Expert Commentary by: William J. Sandborn, MDChief of the Division of Gastroenterology Director of the UCSD IBD Center UC San Diego Health System La Jolla, California. Gastroenterol Hepatol (N Y) 2012; 8(8 Suppl 5):1-24.
  • Boyd HA, Basit S, Harpsøe MC, Wohlfahrt J, Jess T. Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes. PLoS One 2015; 10:e0129567.
  • Ilnyckyji A, Blanchard JF, Rawsthorne P, Bernstein CN. Perianal Crohn's disease and pregnancy: role of the mode of delivery. Am J Gastroenterol 1999; 94:3274-3278.

İnflamatuar bağırsak hastalığı olan gebelerin klinik yönetimi ve sonuçları

Year 2020, Volume: 2 Issue: 4, 122 - 127, 28.12.2020
https://doi.org/10.46969/ezh.751082

Abstract

Amaç: İnflamatuar Bağırsak Hastalıkları (İBH); ülseratif kolit (ÜK) ve Crohn hastalığı (CH) genç yetişkinleri etkileyen kronik
patolojilerdir. Gebelik ve İBH çok boyutludur ve birçok değişkenden etkilenebilir. Bu çalışmada İBH’ı olan gebelerimizin
klinik yönetimlerinin ve gebelik sonuçlarının sunulması amaçlandı.
Gereç ve Yöntem: İBD’si olan gebeler retrospektif olarak incelendi ve ÜK’i ve CH olan hastalar olarak gruplandırıldı.
Toplam dokuz olgu çalışmaya dahil edildi.
Bulgular: Hastaların ortalama yaşı 28,5 ± 4,9 idi. Ortalama gravida ve parite sayıları sırasıyla 2,6 ± 1 ve 1,55 ± 1,13 idi.
İBD’si olan altı hastada ÜK, üç hastada CH mevcuttu. İki hastaya gebelikleri sırasında yeni tanı konuldu, yedi hastada ise
İBH tanısı gebelik öncesinde de mevcuttu. Sekiz hastanın ortalama gebelik haftası 34,2 ± 4,55 hafta idi. Ortalama doğum
ağırlığı, birinci ve beşinci dakika APGAR skorları sırasıyla 2,530 ± 956 gr, 7,6 ± 0,91 ve 8,87 ± 0,83 idi (n=8).
Sonuç: İBH, çocuk doğurma çağında olan birçok kadını etkilemektedir. Gebelik, maternal ve fetal sonuçlar hastalık
aktivitesinden büyük ölçüde etkilenebilmektedir. Hastalık sessiz ise, olası alevlenmelerin hızlı ve etkili yönetimi ile gebe
kalınması tavsiye edilebilir. İBH’nın kontrolü obstetrik prognoz için ana faktördür.

References

  • Huang V, Leung Y, Nguyen GC, Seow CH. Management of Inflammatory Bowel Disease in Pregnancy: A Practical Approach to New Guidelines. Can J Gastroenterol Hepatol 2016; 2016:9513742.
  • Habal FM, Kapila V. Inflammatory bowel disease and pregnancy: evidence, uncertainty and patient decision-making. Can J Gastroenterol 2009; 23:49-53.
  • Dağli Ü. Turkish Inflammatory Bowel Disease Society recommendations on selected topics of ulcerative colitis. Turk J Gastroenterol 2012; 23 Suppl 2:1-2.
  • Yang DH, Keum B, Jeen YT. Capsule Endoscopy for Crohn's Disease: Current Status of Diagnosis and Management. Gastroenterol Res Pract 2016; 2016:8236367.
  • Rogers RG, Katz VL. Course of Crohn's disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol 1995; 12:262-264.
  • O'Toole A, Nwanne O, Tomlinson T. Inflammatory Bowel Disease Increases Risk of Adverse Pregnancy Outcomes: A Meta-Analysis. Dig Dis Sci 2015; 60:2750-2761.
  • Mountifield R, Bampton P, Prosser R, Muller K, Andrews JM. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2009; 15:720-725.
  • Hashash JG, Kane S. Pregnancy and Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2015; 11:96-102.
  • Padhan RK, Kedia S, Garg SK, Bopanna S, Mouli VP, Dhingra R, et al. Long-Term Disease Course and Pregnancy Outcomes in Women with Inflammatory Bowel Disease: An Indian Cohort Study. Dig Dis Sci 2017; 62:2054-2062.
  • Bar-Gil Shitrit A, Grisaru-Granovsky S, Ben Ya'acov A, Goldin E. Management of Inflammatory Bowel Disease During Pregnancy. Dig Dis Sci 2016; 61:2194-2204.
  • Mahadevan U, Cucchiara S, Hyams JS, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol 2011; 106:214-223; quiz 24.
  • Nguyen GC, Seow CH, Maxwell C, et al. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology 2016; 150:734-757.e1.
  • Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes. BJOG 2016; 123:1862-1870.
  • Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis 2011; 17:795-801.
  • Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology 2007; 133:1106-1112.
  • Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med 2000; 160:610-619.
  • Leroy C, Rigot JM, Leroy M, et al. Immunosuppressive drugs and fertility. Orphanet J Rare Dis 2015; 10:136.
  • Pervez H, Usman N, Ahmed MM, Hashmi MS. The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review. Cureus 2019; 11:e5648.
  • Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn's disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology 2000; 47:1595-1598.
  • Ban L, Tata LJ, Humes DJ, Fiaschi L, Card T. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study. Aliment Pharmacol Ther 2015; 42:855-866.
  • Lavie I, Lavie M, Doyev R, Fouks Y, Azem F, Yogev Y. Pregnancy outcomes in women with inflammatory bowel disease who successfully conceived via assisted reproduction technique. Arch Gynecol Obstet 2020; 302:611-618.
  • Czymek R, Limmer S, Kleemann M, et al. Crohn's disease-a chameleon during pregnancy. Langenbecks Arch Surg 2009; 394:517-527.
  • van der Woude CJ, Ardizzone S, Bengtson MB, et al. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9:107-124.
  • Kalkan İ H, Dağli Ü. Safety of drugs used in cases with ulcerative colitis during pregnancy and lactation. Turk J Gastroenterol 2012; 23 Suppl 2:48-56.
  • A SPECIAL MEETING REVIEW EDITION: Highlights in Crohn's Disease and Ulcerative Colitis: Digestive Disease Week 2012 May 19-22, 2012 • San Diego, CaliforniaSpecial Reporting on:• Safety and Efficacy of Subcutaneous Golimumab Induction Therapy in Patients with Moderately to Severely Active UC: PURSUIT-SC• The Future of IBD Therapy: Individualized and Optimized Therapy and Novel Mechanisms• Infliximab Concentration and Clinical Outcome in Patients with UC• Vedolizumab Induction Therapy for UC: Results of GEMINI I, A Randomized, Placebo-Controlled, Double-Blind, Multicenter, Phase III Trial• Novel Infliximab and Antibody-to-lnfliximab Assays Are Predictive of Disease Activity in Patients with CD• Accelerated Step-Care Therapy with Early Azathioprine Versus Conventional Step-Care Therapy in CD• PIANO: A 1,000-Patient Prospective Registry of Pregnancy Outcomes in Women with IBD Exposed to Immunomodulators and Biologic TherapyPLUS Meeting Abstract Summaries With Expert Commentary by: William J. Sandborn, MDChief of the Division of Gastroenterology Director of the UCSD IBD Center UC San Diego Health System La Jolla, California. Gastroenterol Hepatol (N Y) 2012; 8(8 Suppl 5):1-24.
  • Boyd HA, Basit S, Harpsøe MC, Wohlfahrt J, Jess T. Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes. PLoS One 2015; 10:e0129567.
  • Ilnyckyji A, Blanchard JF, Rawsthorne P, Bernstein CN. Perianal Crohn's disease and pregnancy: role of the mode of delivery. Am J Gastroenterol 1999; 94:3274-3278.
There are 27 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Mesut Aydın

Harun Egemen Tolunay 0000-0002-8922-4400

Mustafa Akşar This is me

Barış Boza

Numan Çim

Ahmet Dülger

Recep Yildizhan

Publication Date December 28, 2020
Acceptance Date December 25, 2020
Published in Issue Year 2020 Volume: 2 Issue: 4

Cite

APA Aydın, M., Tolunay, H. E., Akşar, M., Boza, B., et al. (2020). Clinical management and outcomes of pregnant women with inflammatory bowel diseases. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 2(4), 122-127. https://doi.org/10.46969/ezh.751082
AMA Aydın M, Tolunay HE, Akşar M, Boza B, Çim N, Dülger A, Yildizhan R. Clinical management and outcomes of pregnant women with inflammatory bowel diseases. Türk Kadın Sağlığı ve Neonatoloji Dergisi. December 2020;2(4):122-127. doi:10.46969/ezh.751082
Chicago Aydın, Mesut, Harun Egemen Tolunay, Mustafa Akşar, Barış Boza, Numan Çim, Ahmet Dülger, and Recep Yildizhan. “Clinical Management and Outcomes of Pregnant Women With Inflammatory Bowel Diseases”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 2, no. 4 (December 2020): 122-27. https://doi.org/10.46969/ezh.751082.
EndNote Aydın M, Tolunay HE, Akşar M, Boza B, Çim N, Dülger A, Yildizhan R (December 1, 2020) Clinical management and outcomes of pregnant women with inflammatory bowel diseases. Türk Kadın Sağlığı ve Neonatoloji Dergisi 2 4 122–127.
IEEE M. Aydın, H. E. Tolunay, M. Akşar, B. Boza, N. Çim, A. Dülger, and R. Yildizhan, “Clinical management and outcomes of pregnant women with inflammatory bowel diseases”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 2, no. 4, pp. 122–127, 2020, doi: 10.46969/ezh.751082.
ISNAD Aydın, Mesut et al. “Clinical Management and Outcomes of Pregnant Women With Inflammatory Bowel Diseases”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 2/4 (December 2020), 122-127. https://doi.org/10.46969/ezh.751082.
JAMA Aydın M, Tolunay HE, Akşar M, Boza B, Çim N, Dülger A, Yildizhan R. Clinical management and outcomes of pregnant women with inflammatory bowel diseases. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2020;2:122–127.
MLA Aydın, Mesut et al. “Clinical Management and Outcomes of Pregnant Women With Inflammatory Bowel Diseases”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 2, no. 4, 2020, pp. 122-7, doi:10.46969/ezh.751082.
Vancouver Aydın M, Tolunay HE, Akşar M, Boza B, Çim N, Dülger A, Yildizhan R. Clinical management and outcomes of pregnant women with inflammatory bowel diseases. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2020;2(4):122-7.