Treatment for inflammatory bowel disease (IBD) has changed dramatically in the past two decades, largely due to biopharmaceuticals, which help people with ulcerative colitis (UC) and Crohn’s disease (CD) ward off seizures.
But despite major strides in treatment, pregnant women with IBD remain at high risk of developing complications, according to research presented at the Digestive Diseases Week 2022 conference in San Diego last week.
Research on this topic has been sparse, largely because it’s considered too risky to conduct clinical trials on pregnant women, says Anushka Dua, MD, a resident of internal medicine at UCLA who specializes in gastroenterology and IBD, who led The new study team.
One thing doctors definitely understand, Dr. Dua says, is that keeping inflammation under control throughout pregnancy — from conception to delivery — can significantly reduce pregnancy risks.
“It’s hard to say why pregnant women with IBD have high-risk pregnancies because a lot of the research is anecdotal evidence,” Dua says. “We know that biopharmaceuticals are indeed safe during pregnancy and there are no proven adverse effects during pregnancy. In general, if you think about the risks and benefits, there is a much greater risk of allowing the inflammation to persist during pregnancy than of taking the pharmacokinetics.”
For the study, Dua and her team found that 20 years after the introduction of biopharmaceuticals, pregnant women with IBD were still at high risk of developing complications such as pre-eclampsia, high blood pressure during pregnancy, preterm delivery, fetal growth restriction, and having a cesarean section. . Compared to women who did not have IBD. The study has not been peer-reviewed or published.
The study included data from nearly 80,000 pregnant women who had IBD — 40 percent had IBD and 60 percent had Crohn’s disease — and nearly 70,000 pregnant women who did not have IBD. The data was collected over a period of 20 years, which means that the researchers were able to compare pregnancy outcomes prior to widespread use of biopharmaceuticals with how biopharmaceuticals are currently used. The research did not track whether biopharmaceuticals were used during pregnancy, which means that researchers cannot determine whether the drugs improved pregnancy outcomes.
However, the research adds to what researchers understand about the pregnancy risks posed by IBD, but questions remain.
It prompts us to consider why this might happen. Is it that women are reluctant to continue biologic medications during pregnancy, or do some doctors not prescribe them? Doaa says.
Inflammation control is critical
Treatments like biologics can significantly reduce the number of seizures a person has and are safe to use, says Jessica Philpott, MD, PhD, a gastroenterologist at the Institute of Digestive Diseases and Surgery at the Cleveland Clinic, who was not involved in the research. During pregnancy.
“Early in these 20 years, we weren’t so sure. But the more data we have, the more comfortable it is [we are with] “Managing disease with medication during pregnancy,” she says.
For biologics, which are protein therapies, doctors are “very comfortable, and essential to disease management during pregnancy,” Dr. Philpott says, adding that most people stay on biologics throughout pregnancy, although some choose to stop treatment.
“There is still an ever-increasing risk of obstetric outcomes in women with IBD despite these new therapies, so we need to start exploring any barriers to the use of biopharmaceuticals during pregnancy, with a view to developing targeted interventions to mitigate these outcomes,” Dua says. “. . “If biopharmaceuticals are used, we need to explore whether there is another cause besides disease activity that could be causing these adverse outcomes.”
Is it safe to have a baby?
According to the University of Alberta IBD Clinic, inactive IBD usually does not affect a woman’s ability to conceive, and active disease may reduce your chances, but only slightly.
“The research we do is minimal, but people with IBD generally have the same pregnancy rates as the general population,” Dua says.
According to Philpott, a subset of UCSD patients who have had ileoanal anastomosis — or J-sin surgery — may have trouble conceiving naturally within a year of trying and are more likely to seek reproductive assistance such as in vitro fertilization (IVF).
“The good news is that one study showed that IBD patients who underwent IVF are just as likely to get pregnant as people who don’t have IBD,” she says.
In a study published in 2015 in Clinical gastroenterology and hepatology, More than half of people with CD who undergo IVF have had previous surgery for CD. About 35 percent of UCSD patients did. Despite the surgeries associated with IBD and IBD, researchers found that the rate of pregnancy through IVF was the same in people with IBD and those who did not.
If you’re planning to get pregnant, get your IBD under control before you get pregnant
It’s not always possible to predict when you’ll get pregnant, but if you’re planning to have a baby, Dua says it’s important to see a gastroenterologist early on to ensure IBD is well managed.
“Based on our research findings and what has been shown in previous research, active disease during pregnancy or pregnancy is the most concerning,” she explains. The best thing you can do is try to reduce disease activity or reduce symptoms.
“Disease activity during pregnancy has an impact on disease activity during pregnancy,” Dua says. “If you are in remission during pregnancy, you are more likely to remain in remission during pregnancy.”
Conversely, if you had a heart attack during pregnancy, you are more likely to have flare-ups during pregnancy, which can cause complications. During a flare-up, when IBD is considered active, Philpott says, the digestive system can’t absorb nutrients properly, which can cause a developing fetus to be malnourished.
However, it is entirely possible to have a healthy pregnancy when you have IBD. “We just need to monitor them and take care of these patients as they deserve,” she says.
It’s also important for IBD care teams to work with the obstetric team to manage both pregnancy and delivery. C-sections are likely to be overused in people with IBD, Dua notes.
Active perianal disease, in which the anal sphincter is damaged by inflammation, ulcers or fistulas, is usually the only cause associated with IBD, for which a cesarean delivery is necessary. People who have a J cyst may also need a cesarean delivery.
“For many women with IBD, vaginal delivery is really appropriate, so a lot of this will depend on a conversation between the patient and the doctor,” Dua says.