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News

IBD relapses during pregnancy increase preterm birth risk

This month‘s American Journal of Gastroenterology examines in-hospital management and birth outcomes with relapses of IBD during pregnancy.

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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.

Few studies address the effect of such a relapse on birth outcomes in these patients.

83% of patients had a clinical response to these medical treatments
American Journal of Gastroenterology

Dr Seamus Murphy and colleagues from Ireland described the treatment and response rates of severe colitis in pregnancy.

The research team assessed the effects of a severe relapse of colitis during pregnancy on birth outcomes.

The team performed a case control study of pregnant patients with IBD hospitalized for a disease relapse at 2 large treatment centers between 1989 and 2001.

Details of management of disease relapse and maternal and fetal outcomes were recorded.

The researchers identified 18 patients, of which 11 had ulcerative colitis, 6 had Crohn's disease, and 1 had indeterminate colitis.

There were 41 age-matched pregnant IBD patients without disease relapse forming the control group.

Study patients were hospitalized at a mean of 16 week gestation for a mean of 10 days.

All 18 patients received IV hydrocortisone, either continued taking or were commenced on immunomodulators, IV cyclosporine, and azathioprine/mercaptopurine.

The team found that 83% of patients had a clinical response to these medical treatments.

The research team noted that 3 patients required colectomy.

There were significant differences between study and control groups in gestation period, and birth weight.

Dr Murphy's team concluded, "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."

Am J Gastroenterol 2008: 103(5): 1203-9
21 May 2008

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