Dig Dis Sci. 2024 Mar 16. doi: 10.1007/s10620-024-08364-2. Online ahead of print.

Chelsea A DeBolt ¹, Zoë S Gottlieb ², Manasa G Rao ¹, Shaelyn Johnson ¹, Patricia Rekawek ³, Richa Deshpande ⁴, Rachel Meislin ¹, Jill Berkin ¹, Angela Bianco ¹, Maria Teresa Mella ¹, Marla C Dubinsky ⁵

Author information

¹Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, USA.

²Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, Susan and Leonard Feinstein Inflammatory Bowel Diseases Clinical Center, 1 Gustave Levy Place, Annenberg 5, New York, NY, 10029, USA. zoe.gottlieb@mountsinai.org.

³Department of Obstetrics and Gynecology, NYU Langone Health, NYU Langone Hospital Long Island, NYU Long Island School of Medicine, Mineola, NY, USA.

⁴Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

⁵Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, Susan and Leonard Feinstein Inflammatory Bowel Diseases Clinical Center, 1 Gustave Levy Place, Annenberg 5, New York, NY, 10029, USA.

Abstract

Background: The adverse effects of non-steroidal anti-inflammatory (NSAID) drugs on the gastrointestinal system are well recognized, but the effect of NSAID use on disease activity patients with inflammatory bowel disease (IBD) remains unresolved. Low-dose aspirin (LDA) is recommended for all pregnant patients with risk factors for developing preeclampsia, including autoimmune conditions. As recognition of risk factors for preeclampsia improves, the preventative use of LDA is likely to increase.

Aims: To investigate if LDA use for prevention of preeclampsia increases the risk of disease activity in pregnant women with IBD.

Methods: Single-center retrospective cohort study of pregnant patients with IBD who delivered from 2012 to 2020, comparing those with and without LDA use. Primary outcome was odds of clinical IBD activity in patients in remission at time of conception. Secondary outcomes were rate of elevated inflammatory biomarkers, defined as C-reactive protein > 5 ug/mL or fecal calprotectin > 250 ug/g, and rate of preeclampsia. Univariate analyses tested for associations.

Results: Patients taking LDA were older (p = 0.003) and more likely to have chronic hypertension (p = 0.002), to have undergone in vitro fertilization (p < 0.001), and to be on biologics (p = 0.03). Among patients in remission at conception, there was no difference in clinical disease activity or biomarker elevation during pregnancy based on LDA use (OR 1.27, 95% CI [0.55-2.94], p = 0.6). Rates of preeclampsia were similar between groups.

Conclusion: LDA use for preeclampsia prevention did not increase the incidence of disease activity in pregnant patients with IBD.