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Peripartum Infections Comparable Between Pregnant Women with and Without IBD

While cesarean delivery was more likely among women with IBD, this was not associated with an increased risk of peripartum infection.

New data shows peripartum infections are similar between a healthy individual and a pregnant woman with inflammatory bowel disease (IBD).

A team, led by Bar Narkis, MD, the Helen Schneider Hospital for Women, Rabin Medical Center, examined the risk of peripartum infections in patients with IBD compared to a healthy control group and identified potential risk factors linked to peripartum infections.

Pregnant Women With IBD

Pregnant patients with IBD are commonly treated with immunomodulatory agents, which could increase the risk of adverse outcomes such as peripartum infections.

In the retrospective cohort, the investigators compared peripartum infection rates and associated risk factors between pregnant women with and without IBD. The inclusion criteria included women attending a dedicated joint maternal-fetal medicine and gastroenterology clinic for pregnant women with IBD between 2012-2019 at the Rabin Medical Center in Israel.

The investigators included 5 women without IBD matched according to the newborn’s birth date within 2 years, age, parity, and body mass index (BMI) with each patient with IBD.

They defined peripartum infection as any 1 of chorioamnionitis, maternal fever greater than 38°C detected during labor or postpartum hospitalization, and positive culture taken during the hospitalization.

The study included 195 pregnant women with IBD, 37% (n = 72) had ulcerative colitis and 63% (n = 123) had Crohn’s disease. This group was matched with 888 control participants.

Infections

The overall mean disease duration was 8.4 ± 7.02 years and IBD therapy was used by 81% of the patient population. The therapies included 5-aminosalicylic acid (44%) and tumor necrosis factor inhibitors (27%).

The investigators identified peripartum infections in 7.7% (n = 15) of patients and 5.5% (n = 49) of control subjects (P = 1.00).

However, no medication significantly increased the likelihood of peripartum infections. While cesarean delivery was more likely among women with IBD, this was not associated with an increased risk of peripartum infection.

“Peripartum infections were comparable in patients with IBD and control subjects,” the authors wrote. “These reassuring data augment existing knowledge of obstetrical outcomes in IBD patients and contribute to the discussion between caregivers and patients.”

Biologics and Pregnancy

Despite being a relatively new class of treatment for IBD, research continues to show biologics like ustekinumab and vedolizumab are safe and effective, even during pregnancy.

A team, led by Katarina Mitrova, Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s., Charles University, assessed maternal and offspring pregnancy outcomes for pregnant women with IBD treated with ustekinumab or vedolizumab.

With more and more biologics emerging for the treatment of IBD, research on the safety of some of the newer treatments are limited.

For the pregnant women treated with ustekinumab,79.9% (n = 43) resulted in live births, while 20.4% (n = 11) led to spontaneous abortions.

On the other hand, 89.7% (n = 35) of pregnancies on vedolizumab ended in a live birth, while 5.1% (n = 2) ended in spontaneous abortions and 5.1% (n = 2) ended in therapeutic abortions.

Overall there was no significant difference in pregnancy outcomes between either biologic group or the anti-TNF control group (P >0.05).

The study, “Peripartum Infections Among Women With Inflammatory Bowel Disease,” was published online in Inflammatory Bowel Diseases.