Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes.
BACKGROUND
There are few studies that describe the medical treatment and colitis response rates among patients with a severe relapse of inflammatory bowel disease (IBD) during pregnancy, and few studies of the effect of such a relapse on birth outcomes in these patients.


OBJECTIVE
To describe the treatment and response rates of severe colitis in pregnancy, and to assess the effects of a severe relapse of colitis during pregnancy on birth outcomes.


METHODS
We performed a case control study of pregnant patients with IBD hospitalized for a disease relapse at two large treatment centers between 1989 and 2001. Details of management of disease relapse and maternal and fetal outcomes were recorded.


RESULTS
Eighteen patients (11 ulcerative colitis, 6 Crohn's disease, 1 indeterminate colitis), mean age 28.6 yr (range 19-38) formed the study group; 41 age-matched pregnant IBD patients without disease relapse formed the control group. Study patients were hospitalized at a mean of 15.9-wk gestation (range 8-35) for a mean of 10.4 days (range 3-31). All 18 patients received IV hydrocortisone (mean dose 199 mg/day) and 7 patients (39%) either continued taking or were commenced on immunomodulators: IV cyclosporine (5 patients) and azathioprine/6-MP (3 patients). Fifteen patients (83%) had a clinical response to these medical treatments, 3 patients required colectomy. There were significant differences between study and control groups in gestation period (35.0 wk vs 38.7 wk, respectively, P= 0.0001) and birth weight (2,001 g vs 3,018 g, respectively, P < 0.0001).


CONCLUSIONS
Treatment with IV hydrocortisone and IV cyclosporine appears effective at inducing remission of colitis but their use must continue to be confined to severely ill patients being treated at specialized centers. Severe relapses of colitis during pregnancy increase the risk of preterm birth and low birth weight.
Reddy
Deepa
D
Division of Gastroenterology, Mount Sinai Medical Center, One Gustave Levy Place, New York, New York, USA.
Murphy
Seamus J
SJ
Kane
Sunanda V
SV
Present
Daniel H
DH
Kornbluth
Asher A
AA
D000328:Adult; D001034:Apgar Score; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D002585:Cesarean Section; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000276:immunology / Q000628:therapy*; D003424:Crohn Disease / Q000276:immunology / Q000628:therapy*; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy*; D011256:Pregnancy Outcome; D012008:Recurrence
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D006854:Hydrocortisone