Gut. 2022 Sep;71(9):1766-1772. doi: 10.1136/gutjnl-2021-325317. Epub 2021 Oct 22.

Florence-Damilola Odufalu ¹, Millie Long ², Kirk Lin ³, Uma Mahadevan ⁴, PIANO Investigators from the Crohn’s and Colitis Foundation (CCF) Clinical Research Alliance recruited patients for their respective centers for participant enrollment

Collaborators

PIANO Investigators from the Crohn’s and Colitis Foundation (CCF) Clinical Research Alliance recruited patients for their respective centers for participant enrollment:

Doug Wolf, Francis Farraye, Sonia Friedman, Silvia Degli-Esposti, Eugene Greenberg, Christina Ha, Arun Swaminath, Corey Siegel, Robert Erickson, Samir Shah, Bincy Abraham, Ananthakrishnan Ashwin, Sunanda Kane, Daniel Stein, Lilani Perera, Robert McCabe, Marla Dubinsky, Steven Hanauer, Jeffry Katz, Russell Cohen, Sarah Glover, David Elliott, Lisbeth Selby, Kim Isaacs, James Lewis, Joseph Sellin, Eric Ganguly, Sumona Saha, Dawn Beaulieu, Richard Bloomfeld, Dassopoulous Themistocles, Ellen Scherl, Vinita Jacob

Author information

¹Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.

²Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

³Department of Gastroenterology, Palo Alto Medical Foundation, Fremont, California, USA.

⁴Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA uma.mahadevan@ucsf.edu.

Abstract

Objective: Active inflammatory bowel disease (IBD) during pregnancy may require the use of corticosteroids. The aim of this study was to investigate the impact of in utero corticosteroid exposure on adverse pregnancy outcomes, congenital malformations, infections and neurocognitive development among offspring of mothers with IBD.

Design: Using the prospective Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes registry, data were collected at each trimester, delivery; and in the 12 months post partum. Bivariate statistics and multivariate logistic regression models compared pregnancy outcomes by corticosteroid exposure.

Results: A total of 1490 mothers with IBD were enrolled, with 1431 live births recorded. Corticosteroid use was associated with increased risk of preterm birth, small for gestational age, low birth weight (LBW), intrauterine growth restriction and neonatal intensive care unit (NICU) admission. On adjusted multivariate models, corticosteroid use was associated with preterm birth (OR 1.79, 95% CI 1.18 to 2.73), LBW (OR 1.76, 95% CI 1.07 to 2.88) and NICU admission (OR 1.54, 95% CI 1.03 to 2.30). Late corticosteroid use (second and/or third trimester) was associated with serious infections at 9 and 12 months (4% vs 2% and 5% vs 2%, respectively, p=0.03 and p=0.001). There were five newborns with in utero corticosteroid exposure born with orofacial clefts versus one without corticosteroid exposure. Developmental milestones were similar across corticosteroid exposure groups.

Conclusion: In this prospective pregnancy registry, offspring of women exposed to corticosteroids during pregnancy were more likely to have adverse pregnancy outcomes. This emphasises the importance of controlling disease activity before and during pregnancy with steroid-sparing therapy.