The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease

Heidi Kammerlander*, Jan Nielsen, Jens Kjeldsen, Torben Knudsen, Sonia Friedman, Bente Nørgård

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Active inflammatory bowel disease (IBD) during conception and pregnancy may increase the risk of adverse birth outcomes. Former studies have examined heterogeneous groups of women with varying degrees of IBD severity. We aimed to examine the effect of active IBD on birth outcomes in a more homogeneous group of women with a moderate to severe disease course. Since in Denmark, moderate to severe IBD is an indication for use of anti-tumor necrosis factor-α therapy, we examined all women who used anti-tumor necrosis factor therapy during pregnancy. Methods: We identified a nationwide cohort of 219 singleton pregnancies in women treated with anti-tumor necrosis factor-α therapy during pregnancy (2005-2014). Pregnancies with clinical disease activity (65.8%) constituted the exposed cohort and pregnancies without disease activity constituted the unexposed (34.2%). Disease activity scores were supported by levels of fecal calprotectin. Outcomes included low birth weight, preterm birth, and congenital anomalies. Results: In women with IBD, disease activity was associated with adjusted odds ratio of low birth weight and preterm birth; 2.05 (95% confidence interval, 0.37-11.35) and 2.64 (95% confidence interval, 0.85-8.17), respectively. In those with clinical moderate to severe disease activity, the odds ratio for preterm birth was 3.60 (95% confidence interval, 1.14-11.36). In women with ulcerative colitis and disease activity, 19.5% had a child with low birth weight and 29.3% gave birth preterm. Conclusion: In women with moderate to severe IBD, 66% experienced disease activity during pregnancy. In those with the highest degree of disease activity, the risk of preterm birth was increased 3 to 4 folds. The proportion of adverse birth outcomes was high, particularly among women with ulcerative colitis and disease activity.

Original languageEnglish
JournalInflammatory Bowel Diseases
Volume23
Issue number6
Pages (from-to)1011-1018
ISSN1078-0998
DOIs
Publication statusPublished - 2017

Fingerprint

Inflammatory Bowel Diseases
Premature Birth
Low Birth Weight Infant
Tumor Necrosis Factor-alpha
Confidence Intervals
Ulcerative Colitis
Odds Ratio
Denmark

Keywords

  • anti-TNF-α therapy
  • birth outcomes
  • clinical epidemiology
  • inflammatory bowel disease

Cite this

@article{277ad92efa0246ceb93b835a70b81532,
title = "The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease",
abstract = "Background: Active inflammatory bowel disease (IBD) during conception and pregnancy may increase the risk of adverse birth outcomes. Former studies have examined heterogeneous groups of women with varying degrees of IBD severity. We aimed to examine the effect of active IBD on birth outcomes in a more homogeneous group of women with a moderate to severe disease course. Since in Denmark, moderate to severe IBD is an indication for use of anti-tumor necrosis factor-α therapy, we examined all women who used anti-tumor necrosis factor therapy during pregnancy. Methods: We identified a nationwide cohort of 219 singleton pregnancies in women treated with anti-tumor necrosis factor-α therapy during pregnancy (2005-2014). Pregnancies with clinical disease activity (65.8{\%}) constituted the exposed cohort and pregnancies without disease activity constituted the unexposed (34.2{\%}). Disease activity scores were supported by levels of fecal calprotectin. Outcomes included low birth weight, preterm birth, and congenital anomalies. Results: In women with IBD, disease activity was associated with adjusted odds ratio of low birth weight and preterm birth; 2.05 (95{\%} confidence interval, 0.37-11.35) and 2.64 (95{\%} confidence interval, 0.85-8.17), respectively. In those with clinical moderate to severe disease activity, the odds ratio for preterm birth was 3.60 (95{\%} confidence interval, 1.14-11.36). In women with ulcerative colitis and disease activity, 19.5{\%} had a child with low birth weight and 29.3{\%} gave birth preterm. Conclusion: In women with moderate to severe IBD, 66{\%} experienced disease activity during pregnancy. In those with the highest degree of disease activity, the risk of preterm birth was increased 3 to 4 folds. The proportion of adverse birth outcomes was high, particularly among women with ulcerative colitis and disease activity.",
keywords = "anti-TNF-α therapy, birth outcomes, clinical epidemiology, inflammatory bowel disease",
author = "Heidi Kammerlander and Jan Nielsen and Jens Kjeldsen and Torben Knudsen and Sonia Friedman and Bente N{\o}rg{\aa}rd",
year = "2017",
doi = "10.1097/MIB.0000000000001102",
language = "English",
volume = "23",
pages = "1011--1018",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "Lippincott Williams & Wilkins",
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}

The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease. / Kammerlander, Heidi; Nielsen, Jan; Kjeldsen, Jens; Knudsen, Torben; Friedman, Sonia; Nørgård, Bente.

In: Inflammatory Bowel Diseases, Vol. 23, No. 6, 2017, p. 1011-1018.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease

AU - Kammerlander, Heidi

AU - Nielsen, Jan

AU - Kjeldsen, Jens

AU - Knudsen, Torben

AU - Friedman, Sonia

AU - Nørgård, Bente

PY - 2017

Y1 - 2017

N2 - Background: Active inflammatory bowel disease (IBD) during conception and pregnancy may increase the risk of adverse birth outcomes. Former studies have examined heterogeneous groups of women with varying degrees of IBD severity. We aimed to examine the effect of active IBD on birth outcomes in a more homogeneous group of women with a moderate to severe disease course. Since in Denmark, moderate to severe IBD is an indication for use of anti-tumor necrosis factor-α therapy, we examined all women who used anti-tumor necrosis factor therapy during pregnancy. Methods: We identified a nationwide cohort of 219 singleton pregnancies in women treated with anti-tumor necrosis factor-α therapy during pregnancy (2005-2014). Pregnancies with clinical disease activity (65.8%) constituted the exposed cohort and pregnancies without disease activity constituted the unexposed (34.2%). Disease activity scores were supported by levels of fecal calprotectin. Outcomes included low birth weight, preterm birth, and congenital anomalies. Results: In women with IBD, disease activity was associated with adjusted odds ratio of low birth weight and preterm birth; 2.05 (95% confidence interval, 0.37-11.35) and 2.64 (95% confidence interval, 0.85-8.17), respectively. In those with clinical moderate to severe disease activity, the odds ratio for preterm birth was 3.60 (95% confidence interval, 1.14-11.36). In women with ulcerative colitis and disease activity, 19.5% had a child with low birth weight and 29.3% gave birth preterm. Conclusion: In women with moderate to severe IBD, 66% experienced disease activity during pregnancy. In those with the highest degree of disease activity, the risk of preterm birth was increased 3 to 4 folds. The proportion of adverse birth outcomes was high, particularly among women with ulcerative colitis and disease activity.

AB - Background: Active inflammatory bowel disease (IBD) during conception and pregnancy may increase the risk of adverse birth outcomes. Former studies have examined heterogeneous groups of women with varying degrees of IBD severity. We aimed to examine the effect of active IBD on birth outcomes in a more homogeneous group of women with a moderate to severe disease course. Since in Denmark, moderate to severe IBD is an indication for use of anti-tumor necrosis factor-α therapy, we examined all women who used anti-tumor necrosis factor therapy during pregnancy. Methods: We identified a nationwide cohort of 219 singleton pregnancies in women treated with anti-tumor necrosis factor-α therapy during pregnancy (2005-2014). Pregnancies with clinical disease activity (65.8%) constituted the exposed cohort and pregnancies without disease activity constituted the unexposed (34.2%). Disease activity scores were supported by levels of fecal calprotectin. Outcomes included low birth weight, preterm birth, and congenital anomalies. Results: In women with IBD, disease activity was associated with adjusted odds ratio of low birth weight and preterm birth; 2.05 (95% confidence interval, 0.37-11.35) and 2.64 (95% confidence interval, 0.85-8.17), respectively. In those with clinical moderate to severe disease activity, the odds ratio for preterm birth was 3.60 (95% confidence interval, 1.14-11.36). In women with ulcerative colitis and disease activity, 19.5% had a child with low birth weight and 29.3% gave birth preterm. Conclusion: In women with moderate to severe IBD, 66% experienced disease activity during pregnancy. In those with the highest degree of disease activity, the risk of preterm birth was increased 3 to 4 folds. The proportion of adverse birth outcomes was high, particularly among women with ulcerative colitis and disease activity.

KW - anti-TNF-α therapy

KW - birth outcomes

KW - clinical epidemiology

KW - inflammatory bowel disease

U2 - 10.1097/MIB.0000000000001102

DO - 10.1097/MIB.0000000000001102

M3 - Journal article

C2 - 28346274

AN - SCOPUS:85019764188

VL - 23

SP - 1011

EP - 1018

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 6

ER -