Disease activity, treatment de-escalation tied to postpartum IBD flare risk

Last Updated: 2020-01-10

By Anne Harding

NEW YORK (Reuters Health) - Women with inflammatory bowel disease (IBD) have a one-in-three chance of experiencing a disease flare during the postpartum year, new findings show.

"There is a moderate rate of relapse in the post-partum period which is influenced by disease control during pregnancy," Dr. Ashwin N. Ananthakrishnan of Massachusetts General Hospital in Boston told Reuters Health in an email. "Therapy discontinuation or de-escalation pre-pregnancy, intra-partum, or post-partum are the strongest risk factors for these relapse. Thus, women should be optimized in terms of their disease control prior to conception and encouraged to remain on treatment during and following pregnancy for optimal outcomes."

Women with IBD who have active disease when they conceive are at increased risk of poor pregnancy outcomes, but IBD patients whose disease is in remission may not be at increased risk, the authors note in their report in Inflammatory Bowel Diseases.

With dramatic drops in estrogen and progesterone, as well as stress and disrupted sleep, the postpartum period may pose unique risks for women with IBD, although little research has been done on this topic, they add.

To investigate, Dr. Ananthakrishnan and his colleagues looked retrospectively at 206 women with IBD treated at two referral institutions, including 47% with Crohn's disease and 53% with ulcerative colitis. Sixty-five (31.6%) had disease flares in the postpartum year.

Factors associated with flares included disease activity in the third trimester (odds ratio 6.27) and de-escalation of therapy during pregnancy (OR 3.00). Disease type, disease duration and mode of childbirth were not associated with flare risk.

"Studies have consistently shown that disease remission at conception is the best predictor of quiescence during pregnancy, which in turn, is the best predictor of a healthy term baby. So it is important for women to get adequate disease control prior to conception for best outcomes," Dr. Ananthakrishnan said.

The findings are in line with current recommendations that underscore the importance and safety of maintaining IBD therapy during pregnancy, he added.

"Next steps remain trying to understand what factors drive therapy de-escalation during pregnancy and how education can be improved to minimize this occurrence," the researcher said.

SOURCE: http://bit.ly/2sWZBal Inflammatory Bowel Diseases, online January 2, 2020. =