Inflammatory bowel disease (IBD) affects approximately 200 of every 100,000 people in the United States. The two main types of IBD are ulcerative colitis and Crohn's disease. The cause of the disease is not known so medical treatment is geared toward control rather than cure. Effective control measures are important at all times but are especially important during pregnancy.
Of the two forms of the disease, ulcerative colitis, poses the biggest risks to pregnancy. The recently published findings of a large study on the IBD influence during pregnancy suggests it is beneficial to plan conception during a period of remission rather than when IBD is in an active stage.
Dr. Darios Getahun led the study of 395,781 who delivered a single child between 2000 and 2012. All the women were patients of the Kaiser Permanente Southern California Medical Group, where Getahun is a researcher.
The IBD rate among the pregnant women was approximately 130 for every 100,000 pregnancies. During an initial examination of the medical data, the research team discovered IBD patients were at increased risk for certain pregnancy complications:
- 46% more likely than someone without IBD to have a child small for gestational age.
- 32% more likely to experience spontaneous preterm delivery.
- Twice as likely to experience premature rupture of the placenta.
The spontaneous preterm deliveries were problematic but not necessarily severe. They occurred, on average, between weeks 34 and 36 of the pregnancy, instead of during the 39th and 40th week.
Further analysis of the data revealed the pregnancy complications occurred most often in patients with ulcerative colitis rather than Crohn's disease. The difference between pregnancy risks in women with ulcerative colitis was found to be statistically significant over those with Crohn's.
Getahun's research team suggests that practitioners of maternal-fetal medicine become familiar with the form of IBD a maternity patient has. It's also important to know if a woman was experiencing an uncontrolled, or active state, of disease at the time of conception. Those in remission at conception tend to stay in remission throughout the pregnancy while those in the active state tend to stay in the active state throughout the pregnancy.
When conception occurs during a state of remission, the researchers consider it crucial that a woman continues taking whatever medications put the IBD into remission. Achieving a state of IBD remission during pregnancy is quite difficult. Getahun's team suggests preconception counseling that includes a woman, her IBD specialist and a maternal-fetal medicine specialist who can all work in conjunction throughout the pregnancy to devise the safest, most effective plan for IBD control during pregnancy.
Source: Getahun, Darios, et al. "Association between maternal inflammatory bowel disease and adverse perinatal outcomes." Journal of Perinatology. Nature Publishing Group /Macmillan Publishers Limited. Mar 20, 2014. Web. Apr 18, 2014.