Histological remission in inflammatory bowel disease and risk of adverse pregnancy outcomes : A nationwide study
(2022) In EClinicalMedicine 53.- Abstract
Background: Inflammatory bowel disease (IBD) has been linked to adverse pregnancy outcomes, but it is unclear how risks vary by histological activity. Methods: We performed a nationwide study of Swedish women diagnosed with IBD 1990–2016 and a pre-pregnancy (<12 months) colorectal biopsy with vs. without histological inflammation (1223 and 630 births, respectively). We also examined pregnancy outcomes in 2007–2016 of women with vs. without clinically active IBD (i.e., IBD-related hospitalization, surgery, or medication escalation) <12 months before pregnancy (2110 and 4993 births, respectively). Accounting for smoking, socio-demographics, and comorbidities, generalized linear models estimated adjusted risk ratios (aRRs) for... (More)
Background: Inflammatory bowel disease (IBD) has been linked to adverse pregnancy outcomes, but it is unclear how risks vary by histological activity. Methods: We performed a nationwide study of Swedish women diagnosed with IBD 1990–2016 and a pre-pregnancy (<12 months) colorectal biopsy with vs. without histological inflammation (1223 and 630 births, respectively). We also examined pregnancy outcomes in 2007–2016 of women with vs. without clinically active IBD (i.e., IBD-related hospitalization, surgery, or medication escalation) <12 months before pregnancy (2110 and 4993 births, respectively). Accounting for smoking, socio-demographics, and comorbidities, generalized linear models estimated adjusted risk ratios (aRRs) for preterm birth (<37 gestational weeks) and small-for-gestational age (SGA, <10th percentile weight for age). Findings: Of infants to women with vs. without histological inflammation, 9.6% (n = 117) and 6.5% (n = 41) were preterm, respectively (aRR = 1.46; 95%CI = 1.03–2.06). Histological inflammation was associated with preterm birth in ulcerative colitis (UC) (aRR = 1.64; 95%CI = 1.07–2.52), especially extensive colitis (aRR = 2.37; 95%CI = 1.12–5.02), but not in Crohn's disease (aRR = 0.99; 95%CI = 0.55–1.78). Of infants to women with vs. without histological inflammation, 116 (9.6%) and 56 (8.9%), respectively, were SGA (aRR = 1.09; 95%CI = 0.81–1.47). Clinically active disease before pregnancy was linked to preterm birth (aRR = 1.42; 95%CI = 1.20–1.69), but not to SGA birth (aRR = 1.13; 95%CI = 0.96–1.32). Finally, of infants to women without clinical activity, histological inflammation was not significantly associated with preterm birth (aRR = 1.20; 95%CI = 0.68–2.13). Interpretation: Histological and clinical activity in IBD, especially in UC, were risk factors for preterm birth. Further research is needed to determine the importance of pre-pregnancy histological activity in women without clinically-defined disease activity. Funding: The Swedish Society of Medicine.
(Less)
- author
- Mårild, Karl ; Söderling, Jonas ; Stephansson, Olof ; Axelrad, Jordan ; Halfvarson, Jonas ; Bröms, Gabriella ; Marsal, Jan LU ; Olén, Ola and Ludvigsson, Jonas F.
- author collaboration
- organization
- publishing date
- 2022-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Histology, Population-based, Pregnancy
- in
- EClinicalMedicine
- volume
- 53
- article number
- 101722
- publisher
- Lancet Publishing Group
- external identifiers
-
- scopus:85142709521
- pmid:36467453
- ISSN
- 2589-5370
- DOI
- 10.1016/j.eclinm.2022.101722
- language
- English
- LU publication?
- yes
- id
- 35da512d-0da5-470a-9dfb-9a64e84bcde1
- date added to LUP
- 2022-12-28 11:42:03
- date last changed
- 2023-03-20 08:04:05
@article{35da512d-0da5-470a-9dfb-9a64e84bcde1,
abstract = {{<p>Background: Inflammatory bowel disease (IBD) has been linked to adverse pregnancy outcomes, but it is unclear how risks vary by histological activity. Methods: We performed a nationwide study of Swedish women diagnosed with IBD 1990–2016 and a pre-pregnancy (<12 months) colorectal biopsy with vs. without histological inflammation (1223 and 630 births, respectively). We also examined pregnancy outcomes in 2007–2016 of women with vs. without clinically active IBD (i.e., IBD-related hospitalization, surgery, or medication escalation) <12 months before pregnancy (2110 and 4993 births, respectively). Accounting for smoking, socio-demographics, and comorbidities, generalized linear models estimated adjusted risk ratios (aRRs) for preterm birth (<37 gestational weeks) and small-for-gestational age (SGA, <10th percentile weight for age). Findings: Of infants to women with vs. without histological inflammation, 9.6% (n = 117) and 6.5% (n = 41) were preterm, respectively (aRR = 1.46; 95%CI = 1.03–2.06). Histological inflammation was associated with preterm birth in ulcerative colitis (UC) (aRR = 1.64; 95%CI = 1.07–2.52), especially extensive colitis (aRR = 2.37; 95%CI = 1.12–5.02), but not in Crohn's disease (aRR = 0.99; 95%CI = 0.55–1.78). Of infants to women with vs. without histological inflammation, 116 (9.6%) and 56 (8.9%), respectively, were SGA (aRR = 1.09; 95%CI = 0.81–1.47). Clinically active disease before pregnancy was linked to preterm birth (aRR = 1.42; 95%CI = 1.20–1.69), but not to SGA birth (aRR = 1.13; 95%CI = 0.96–1.32). Finally, of infants to women without clinical activity, histological inflammation was not significantly associated with preterm birth (aRR = 1.20; 95%CI = 0.68–2.13). Interpretation: Histological and clinical activity in IBD, especially in UC, were risk factors for preterm birth. Further research is needed to determine the importance of pre-pregnancy histological activity in women without clinically-defined disease activity. Funding: The Swedish Society of Medicine.</p>}},
author = {{Mårild, Karl and Söderling, Jonas and Stephansson, Olof and Axelrad, Jordan and Halfvarson, Jonas and Bröms, Gabriella and Marsal, Jan and Olén, Ola and Ludvigsson, Jonas F.}},
issn = {{2589-5370}},
keywords = {{Histology; Population-based; Pregnancy}},
language = {{eng}},
publisher = {{Lancet Publishing Group}},
series = {{EClinicalMedicine}},
title = {{Histological remission in inflammatory bowel disease and risk of adverse pregnancy outcomes : A nationwide study}},
url = {{http://dx.doi.org/10.1016/j.eclinm.2022.101722}},
doi = {{10.1016/j.eclinm.2022.101722}},
volume = {{53}},
year = {{2022}},
}