Endoscopy during pregnancy tied to small excess risk of preterm birth

Last Updated: 2016-10-27

By Reuters Staff

NEW YORK (Reuters Health) - Performing endoscopy during pregnancy is associated with a slight increase in the risk of preterm birth or small-for-gestational age (SGA) babies, a Swedish population-based study suggests.

"Earlier recommendations suggest that endoscopy should only be performed during pregnancy if there are strong indications, and if so not during the second trimester. Our study shows that endoscopy is unlikely to have a more than marginal influence on pregnancy outcome independently of trimester," the study team concludes in a report online October 20 in Gastroenterology.

Using Swedish registry data, Dr. Jonas Ludvigsson from Karolinska Institutet in Stockholm and colleagues compared the pregnancy outcome in roughly 3,000 pregnancies exposed to endoscopy (mainly upper and lower endoscopy) and about 1.6 million unexposed pregnancies.

They found that exposure to any endoscopy during pregnancy was associated with a significant increased risk of preterm birth (adjusted relative risk, 1.54) and SGA (ARR, 1.30), but not of congenital malformation or stillbirth. Risks of adverse pregnancy outcome did not seem to differ by trimester.

Compared with women who had endoscopy less than 12 months before or after pregnancy, endoscopy during pregnancy was significantly associated with preterm birth (ARR, 1.16) but not with SGA (ARR, 1.19), stillbirth (ARR, 1.11), or congenital malformation (ARR, 0.90).

When the analysis was restricted to women having an endoscopy before, during or after pregnancy, and only those without a diagnosis of inflammatory bowel disease, celiac disease, or liver disease, endoscopy during pregnancy was not linked to preterm birth (ARR, 1.03).

In the final analysis, the researchers compared births within the same mother, for which only one birth had been exposed to endoscopy, and found no association between endoscopy and gestational age or birth weight.

The authors conclude, "Although endoscopy during pregnancy may be associated with adverse pregnancy outcome, excess risks are small and likely due to intrafamilial factors or underlying disease activity."

Adverse pregnancy outcome in women undergoing endoscopy during pregnancy is "rare," they add. "Potential excess risks, if any, seem minimal and should be weighed against the need for timely investigation and treatment of women where an underlying GI disease per se may be a more severe threat to pregnancy outcome than the endoscopy."

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: http://bit.ly/2ewcChk

Gastroenterology 2016.