The pregnancy outcome and drug usage during pregnancy among Taiwanese inflammatory bowel disease patients

Abstract

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by relapsing inflammation and severe mucosal damage in the intestine. Young IBD women are often worried about their fertility, the disease activity during pregnancy, the heritability of the disease to their unborn child, and also the effect of their disease on the pregnancy itself. The pregnancy outcome and drug usage during pregnancy are rarely discussed in an area of low IBD prevalence. To evaluate (a) decision-making around drug therapy during pregnancy and (b) the prognosis for pregnant IBD patients in an area of low IBD prevalence. We conducted a retrospective analysis across seven medical centers in Taiwan from February 2009 to February 2019. Maternal and fetal/neonatal outcomes were analyzed. A total of 17 patients (21 pregnancies) were enrolled. The mean age of patients was 35.9 ± 4.6 years. Six patients (35.3%) had fertility worries and two (11.8%) had infertility. Five patients had Crohn's disease (CD), of whom 60% had undergone prior abdominal surgery. The remaining 12 patients had ulcerative colitis (UC), of whom 8.3% had undergone prior abdominal surgery (significantly lower than CD patients [P = .02]). There were no significant differences between the CD and UC groups in terms of age, age of primigravida, height, weight, fertility worries, or infertility. Abortion, miscarriage, or stillbirth was seen in 23.8% of patients, and 14.3% of patients needed treatment to prevent miscarriage. Low birth weight (<2500 g) was seen in 14.3% of births, and 14.3% had associated complications. There was no significant difference between CD and UC patients in terms of pregnancy outcome. During pregnancy, 33.3% of patients changed their drug regimens, stopping the use of 5-ASA (9.5%), immunosuppressants (4.8%), corticosteroids (4.8%), or biologics (9.5%). However, if IBD progressed during pregnancy, corticosteroids were considered (19.4%) for disease control. These are real-world experiences of IBD during pregnancy in Taiwan. High rates of abortion, miscarriage, or stillbirth and treatment to prevent miscarriage were noted. Among all subjects, 33.3% of patients changed their drug regimen during pregnancy. Corticosteroids were also considered if IBD progressed during pregnancy in this study.