Dedicated joint inflammatory bowel disease-Antenatal clinics are associated with better pregnancy and neonatal outcomes in patients with active inflammatory bowel disease during pregnancy: Results from a large uk multi-centre cohort

Abstract

Background: Active inflammatory bowel disease (IBD) during pregnancy is associated with an increased risk of adverse outcomes. Identifying predictors can inform targeted interventions. Method(s): A multi-centre retrospective cohort study was conducted across 16 UK sites, 8 of which offered a joint IBD-Antenatal clinic. Pregnant patients with active IBD defined by clinical symptoms and/or elevated FCP (>=250 mug/g) or CRP (>=5 mg/L)-and either (i) change in IBD therapy (ii) IBD-related hospitalisation or (iii) IBD related surgery were included. Composite endpoints were: A. Adverse IBD outcome; IBD related hospitalisation or luminal surgery during pregnancy. b. Adverse pregnancy or neonatal outcome; 1 of spontaneous pregnancy loss, small-for-gestational-Age infant, fetal growth restriction, low birth weight (= 3 biologics (RRR 3.91, 95% CI 1.47-10.35; p = 0.006), moderate-severe disease at pre-conception (RRR 2.98, 95% CI 1.24-7.12; p = 0.014) or at flare onset (RRR 2.94, 95% CI 1.04-8.27; p = 0.041). Initiation of corticosteroids (RRR 7.24, 95% CI 3.85-13.62; p < 0.0005) or biologics (RRR 2.85, 95% CI 1.45-5.61; p = 0.002) during pregnancy were also associated with adverse IBD outcomes. An Adverse pregnancy or neonatal outcome occurred in 33.3% (n = 133), associated with persistence of active disease post-induction of definitive therapy (RRR 1.29, 95% CI 1.04-5.30; p = 0.039) and emergency caesarean section (RRR 3.13, 95% CI 1.56-6.26; p = 0.001). Management in a joint IBD-Antenatal clinic was protective (RRR 0.40, 95% CI 0.22-0.72; p = 0.002), with a lower rate of adverse PAN outcomes compared to single speciality clinics (29.4% vs 50.7%, p < 0.001). Conclusion(s): This study highlights a high-risk cohort requiring personalised pre-conception counselling and enhanced monitoring in pregnancy. Care within a dedicated IBD-Antenatal clinic was associated with a lower rate of adverse outcomes, supporting embedding of this multidisciplinary model as standard of care for management of IBD in pregnancy.