Fecal Calprotectin during Pregnancy in Women with Moderate-Severe Inflammatory Bowel Disease

Heidi Kammerlander*, Jan Nielsen, Jens Kjeldsen, Torben Knudsen, Kim Oren Gradel, Sonia Friedman, Bente Mertz Nørgård

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background Fecal calprotectin (FC) is a biomarker used for assessing disease activity among IBD patients. Sparse knowledge exists as to whether FC correlates with clinical disease activity during pregnancy. Our aim was to assess FC and selected biomarkers in women with moderate-severe IBD and correlate them with clinical disease activity scores in pregnant women. Methods We identified a nationwide cohort of 219 singleton pregnancies in women with moderate-severe disease (all treated with anti-tumor recrosis factor-α [anti-TNF-α] therapy during pregnancy), and we reviewed the medical records to extract clinical details and information on biomarkers. FC, C-reactive protein (CRP), hemoglobin, and albumin were collected according to each trimester. Results A total of 346 FC measurements were obtained throughout the gestational periods. FC values were between 80-120, 259-349, and 778-1277 mg/kg in women with clinically inactive, mild, and moderate-severe disease activity, respectively, and were significantly higher among the women with clinical disease activity. ROC curves for disease activity were computed according to the preconception period: 0.81 (95% confidence interval [CI], 0.69-0.93), first trimester: 0.73 (95% CI, 0.60-0.86), second trimester: 0.74 (95% CI, 0.62-0.86), and third trimester: 0.76 (95% CI, 0.64-0.88), respectively. We found a sensitivity of 69.7%-80.0%, a specificity of 66.7%-73.3%, and a positive predictive value of 66.7%-74.4% over the 4 gestational periods when a cutoff of 200 mg/kg was used. We found no clinically significant differences in CRP, albumin, or hemoglobin. Conclusions FC in pregnant women with moderate-severe IBD treated with anti-TNF-α therapy was significantly higher in women with clinical disease activity compared with the women without. FC correlated with the level of clinical disease activity in all gestational periods.

Original languageEnglish
JournalInflammatory Bowel Diseases
Volume24
Issue number4
Pages (from-to)839-848
ISSN1078-0998
DOIs
Publication statusPublished - 19. Mar 2018

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Inflammatory Bowel Diseases
Confidence Intervals
Pregnant Women
Albumins
Third Pregnancy Trimester
Second Pregnancy Trimester
First Pregnancy Trimester
ROC Curve
Medical Records

Keywords

  • fecal calprotectin
  • inflammatory bowel disease
  • pregnancy

Cite this

@article{4ff386205d9e4efbac803002f27fa702,
title = "Fecal Calprotectin during Pregnancy in Women with Moderate-Severe Inflammatory Bowel Disease",
abstract = "Background Fecal calprotectin (FC) is a biomarker used for assessing disease activity among IBD patients. Sparse knowledge exists as to whether FC correlates with clinical disease activity during pregnancy. Our aim was to assess FC and selected biomarkers in women with moderate-severe IBD and correlate them with clinical disease activity scores in pregnant women. Methods We identified a nationwide cohort of 219 singleton pregnancies in women with moderate-severe disease (all treated with anti-tumor recrosis factor-α [anti-TNF-α] therapy during pregnancy), and we reviewed the medical records to extract clinical details and information on biomarkers. FC, C-reactive protein (CRP), hemoglobin, and albumin were collected according to each trimester. Results A total of 346 FC measurements were obtained throughout the gestational periods. FC values were between 80-120, 259-349, and 778-1277 mg/kg in women with clinically inactive, mild, and moderate-severe disease activity, respectively, and were significantly higher among the women with clinical disease activity. ROC curves for disease activity were computed according to the preconception period: 0.81 (95{\%} confidence interval [CI], 0.69-0.93), first trimester: 0.73 (95{\%} CI, 0.60-0.86), second trimester: 0.74 (95{\%} CI, 0.62-0.86), and third trimester: 0.76 (95{\%} CI, 0.64-0.88), respectively. We found a sensitivity of 69.7{\%}-80.0{\%}, a specificity of 66.7{\%}-73.3{\%}, and a positive predictive value of 66.7{\%}-74.4{\%} over the 4 gestational periods when a cutoff of 200 mg/kg was used. We found no clinically significant differences in CRP, albumin, or hemoglobin. Conclusions FC in pregnant women with moderate-severe IBD treated with anti-TNF-α therapy was significantly higher in women with clinical disease activity compared with the women without. FC correlated with the level of clinical disease activity in all gestational periods.",
keywords = "fecal calprotectin, inflammatory bowel disease, pregnancy",
author = "Heidi Kammerlander and Jan Nielsen and Jens Kjeldsen and Torben Knudsen and Gradel, {Kim Oren} and Sonia Friedman and N{\o}rg{\aa}rd, {Bente Mertz}",
year = "2018",
month = "3",
day = "19",
doi = "10.1093/ibd/izx055",
language = "English",
volume = "24",
pages = "839--848",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "Lippincott Williams & Wilkins",
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}

Fecal Calprotectin during Pregnancy in Women with Moderate-Severe Inflammatory Bowel Disease. / Kammerlander, Heidi; Nielsen, Jan; Kjeldsen, Jens; Knudsen, Torben; Gradel, Kim Oren; Friedman, Sonia; Nørgård, Bente Mertz.

In: Inflammatory Bowel Diseases, Vol. 24, No. 4, 19.03.2018, p. 839-848.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Fecal Calprotectin during Pregnancy in Women with Moderate-Severe Inflammatory Bowel Disease

AU - Kammerlander, Heidi

AU - Nielsen, Jan

AU - Kjeldsen, Jens

AU - Knudsen, Torben

AU - Gradel, Kim Oren

AU - Friedman, Sonia

AU - Nørgård, Bente Mertz

PY - 2018/3/19

Y1 - 2018/3/19

N2 - Background Fecal calprotectin (FC) is a biomarker used for assessing disease activity among IBD patients. Sparse knowledge exists as to whether FC correlates with clinical disease activity during pregnancy. Our aim was to assess FC and selected biomarkers in women with moderate-severe IBD and correlate them with clinical disease activity scores in pregnant women. Methods We identified a nationwide cohort of 219 singleton pregnancies in women with moderate-severe disease (all treated with anti-tumor recrosis factor-α [anti-TNF-α] therapy during pregnancy), and we reviewed the medical records to extract clinical details and information on biomarkers. FC, C-reactive protein (CRP), hemoglobin, and albumin were collected according to each trimester. Results A total of 346 FC measurements were obtained throughout the gestational periods. FC values were between 80-120, 259-349, and 778-1277 mg/kg in women with clinically inactive, mild, and moderate-severe disease activity, respectively, and were significantly higher among the women with clinical disease activity. ROC curves for disease activity were computed according to the preconception period: 0.81 (95% confidence interval [CI], 0.69-0.93), first trimester: 0.73 (95% CI, 0.60-0.86), second trimester: 0.74 (95% CI, 0.62-0.86), and third trimester: 0.76 (95% CI, 0.64-0.88), respectively. We found a sensitivity of 69.7%-80.0%, a specificity of 66.7%-73.3%, and a positive predictive value of 66.7%-74.4% over the 4 gestational periods when a cutoff of 200 mg/kg was used. We found no clinically significant differences in CRP, albumin, or hemoglobin. Conclusions FC in pregnant women with moderate-severe IBD treated with anti-TNF-α therapy was significantly higher in women with clinical disease activity compared with the women without. FC correlated with the level of clinical disease activity in all gestational periods.

AB - Background Fecal calprotectin (FC) is a biomarker used for assessing disease activity among IBD patients. Sparse knowledge exists as to whether FC correlates with clinical disease activity during pregnancy. Our aim was to assess FC and selected biomarkers in women with moderate-severe IBD and correlate them with clinical disease activity scores in pregnant women. Methods We identified a nationwide cohort of 219 singleton pregnancies in women with moderate-severe disease (all treated with anti-tumor recrosis factor-α [anti-TNF-α] therapy during pregnancy), and we reviewed the medical records to extract clinical details and information on biomarkers. FC, C-reactive protein (CRP), hemoglobin, and albumin were collected according to each trimester. Results A total of 346 FC measurements were obtained throughout the gestational periods. FC values were between 80-120, 259-349, and 778-1277 mg/kg in women with clinically inactive, mild, and moderate-severe disease activity, respectively, and were significantly higher among the women with clinical disease activity. ROC curves for disease activity were computed according to the preconception period: 0.81 (95% confidence interval [CI], 0.69-0.93), first trimester: 0.73 (95% CI, 0.60-0.86), second trimester: 0.74 (95% CI, 0.62-0.86), and third trimester: 0.76 (95% CI, 0.64-0.88), respectively. We found a sensitivity of 69.7%-80.0%, a specificity of 66.7%-73.3%, and a positive predictive value of 66.7%-74.4% over the 4 gestational periods when a cutoff of 200 mg/kg was used. We found no clinically significant differences in CRP, albumin, or hemoglobin. Conclusions FC in pregnant women with moderate-severe IBD treated with anti-TNF-α therapy was significantly higher in women with clinical disease activity compared with the women without. FC correlated with the level of clinical disease activity in all gestational periods.

KW - fecal calprotectin

KW - inflammatory bowel disease

KW - pregnancy

U2 - 10.1093/ibd/izx055

DO - 10.1093/ibd/izx055

M3 - Journal article

VL - 24

SP - 839

EP - 848

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 4

ER -