title: Extent of disease is a major outcome predictor in patients with ulcerative colitis and pregnancy.
abstract: OBJECTIVE
  There exists a two-way interaction between pregnancy and inflammatory bowel disease (IBD) wherein pregnancy may influence disease activity of the underlying IBD, and conversely, the status of the disease may have a direct effect on the outcome of pregnancy. Disease activity at the time of conception is considered the major determinant of the outcome of pregnancy. We evaluated the effect of disease extent on the outcome of pregnancy.
  
  
  METHODS
  Forty-three females with ulcerative colitis and coexisting pregnancy were studied over a 4-year period from January 2010 to December 2013. Patients were divided into two groups on the basis of the extent of the disease determined prior to the onset of the pregnancy. Group I (n = 22) comprised of patients with pancolitis, whereas group II (n = 21) had disease limited to the splenic flexure. The following information regarding the outcome of the pregnancy or spontaneous abortion was obtained after informed consent: place of delivery (home or hospital), gestational length, mode of delivery, birth weight, congenital anomalies, drug treatment, compliance, and relapse during pregnancy if any. Data were compared between the two groups.
  
  
  RESULTS
  Females with pancolitis had a mean age of 25.1 years with a disease duration of 4.2 years which was similar to patients in group II who had a mean age of 25.2 years and disease duration of 4 years (p = ns for both). Females in group I had a significantly higher rate of spontaneous abortions (n = 5 [23 %]), preterm delivery (n = 8 [36 %]), and low birth weight (n = 11 [50 %]) than patients in group II (0 [0 %], 1 [5 %], and 3 [14 %], respectively; p-values being <0.04, <0.02, and <0.02, respectively). Frequency of Caesarean section in group I and group II was 45 % and 19 %, respectively (p = 0.06). Frequency of disease relapse was higher in group I compared to group II (11 [50 %] vs. 3 [14 %], p < 0.02). None of the newborns in either group were detected to have any major congenital anomaly. On multivariate analysis using logistic regression, disease extent was the only independent predictor of adverse obstetrical outcomes.
  
  
  CONCLUSIONS
  Our study suggests that disease extent is a major determinant of the outcome of pregnancy in patients with ulcerative colitis. Patients with pancolitis may be at a higher risk of obstetric complications of ulcerative colitis vs. those with limited disease.
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, 110 002, India, amarender.puri@gmail.com.
authors.forename: Amarender
authors.initials: A
authors.lastname: Puri
authors.forename: Vaishali
authors.initials: V
authors.lastname: Bharadwaj
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006801:Humans; D007230:Infant, Low Birth Weight; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D055815:Young Adult