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Histologic Remission in Inflammatory Bowel Disease and Female Fertility : A Nationwide Study

Mårild, Karl ; Söderling, Jonas ; Stephansson, Olof ; Axelrad, Jordan ; Halfvarson, Jonas ; Bröms, Gabriella ; Marsal, Jan LU ; Olén, Ola and Ludvigsson, Jonas F. (2024) In Gastroenterology
Abstract

Background & Aims: Inflammatory bowel disease (IBD) is linked to reduced female fertility, but it is unclear how fertility rates vary by histologic disease activity. Methods: Nationwide IBD cohort of Swedish women aged 15 to 44 years. We examined fertility rates during periods with vs without histologic inflammation (n = 21,046; follow-up, 1990–2016) and during periods with vs without clinical activity (IBD-related hospitalization, surgery, or treatment escalation) (n = 24,995; follow-up, 2006–2020). Accounting for sociodemographics and comorbidities, we used Poisson regression to estimate adjusted fertility rate ratios (aFRRs) for live births conceived during 12-month periods of histologic inflammation (vs histologic remission) and... (More)

Background & Aims: Inflammatory bowel disease (IBD) is linked to reduced female fertility, but it is unclear how fertility rates vary by histologic disease activity. Methods: Nationwide IBD cohort of Swedish women aged 15 to 44 years. We examined fertility rates during periods with vs without histologic inflammation (n = 21,046; follow-up, 1990–2016) and during periods with vs without clinical activity (IBD-related hospitalization, surgery, or treatment escalation) (n = 24,995; follow-up, 2006–2020). Accounting for sociodemographics and comorbidities, we used Poisson regression to estimate adjusted fertility rate ratios (aFRRs) for live births conceived during 12-month periods of histologic inflammation (vs histologic remission) and 3-month periods of clinically active IBD (vs quiescent IBD). Results: During periods with vs without histologic inflammation, there were 6.35 (95% confidence interval [CI], 5.98–6.73) and 7.09 (95% CI, 6.48–7.70) live births conceived per 100 person-years of follow-up, respectively, or 1 fewer child per 14 women with 10 years of histologic inflammation (aFRR, 0.90; 95% CI, 0.81–1.00). In women with histologic inflammation, fertility was similarly reduced in ulcerative colitis (UC) (aFRR, 0.89 [95% CI, 0.78–1.02]) and Crohn's disease (CD) (aFRR, 0.86 [95% CI, 0.72–1.04]). Clinical IBD activity was associated with an aFRR of 0.76 (95% CI, 0.72–0.79) or 1 fewer child per 6 women with 10 years of clinical activity. Fertility was reduced in clinically active UC (aFRR, 0.75 [95% CI, 0.70–0.81]) and CD (aFRR, 0.76 [95% CI, 0.70–0.82]). Finally, among women with clinically quiescent IBD, histologic inflammation (vs histologic remission) was associated with reduced fertility (aFRR, 0.85 [95% CI, 0.73–0.98]). Conclusions: An association between histologic and clinical activity and reduced female fertility in CD and UC was found. Notably, histologic inflammation was also linked to reduced fertility in women with clinically quiescent IBD.

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type
Contribution to journal
publication status
epub
subject
keywords
Histology, Population-Based, Remission
in
Gastroenterology
publisher
Elsevier
external identifiers
  • pmid:38331202
  • scopus:85188431789
ISSN
0016-5085
DOI
10.1053/j.gastro.2024.01.018
language
English
LU publication?
yes
id
806325a8-0485-4efc-9ec4-f7d5e32790f5
date added to LUP
2024-04-11 11:13:30
date last changed
2024-06-06 18:30:56
@article{806325a8-0485-4efc-9ec4-f7d5e32790f5,
  abstract     = {{<p>Background &amp; Aims: Inflammatory bowel disease (IBD) is linked to reduced female fertility, but it is unclear how fertility rates vary by histologic disease activity. Methods: Nationwide IBD cohort of Swedish women aged 15 to 44 years. We examined fertility rates during periods with vs without histologic inflammation (n = 21,046; follow-up, 1990–2016) and during periods with vs without clinical activity (IBD-related hospitalization, surgery, or treatment escalation) (n = 24,995; follow-up, 2006–2020). Accounting for sociodemographics and comorbidities, we used Poisson regression to estimate adjusted fertility rate ratios (aFRRs) for live births conceived during 12-month periods of histologic inflammation (vs histologic remission) and 3-month periods of clinically active IBD (vs quiescent IBD). Results: During periods with vs without histologic inflammation, there were 6.35 (95% confidence interval [CI], 5.98–6.73) and 7.09 (95% CI, 6.48–7.70) live births conceived per 100 person-years of follow-up, respectively, or 1 fewer child per 14 women with 10 years of histologic inflammation (aFRR, 0.90; 95% CI, 0.81–1.00). In women with histologic inflammation, fertility was similarly reduced in ulcerative colitis (UC) (aFRR, 0.89 [95% CI, 0.78–1.02]) and Crohn's disease (CD) (aFRR, 0.86 [95% CI, 0.72–1.04]). Clinical IBD activity was associated with an aFRR of 0.76 (95% CI, 0.72–0.79) or 1 fewer child per 6 women with 10 years of clinical activity. Fertility was reduced in clinically active UC (aFRR, 0.75 [95% CI, 0.70–0.81]) and CD (aFRR, 0.76 [95% CI, 0.70–0.82]). Finally, among women with clinically quiescent IBD, histologic inflammation (vs histologic remission) was associated with reduced fertility (aFRR, 0.85 [95% CI, 0.73–0.98]). Conclusions: An association between histologic and clinical activity and reduced female fertility in CD and UC was found. Notably, histologic inflammation was also linked to reduced fertility in women with clinically quiescent IBD.</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         = {{0016-5085}},
  keywords     = {{Histology; Population-Based; Remission}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Gastroenterology}},
  title        = {{Histologic Remission in Inflammatory Bowel Disease and Female Fertility : A Nationwide Study}},
  url          = {{http://dx.doi.org/10.1053/j.gastro.2024.01.018}},
  doi          = {{10.1053/j.gastro.2024.01.018}},
  year         = {{2024}},
}