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Research Finds Association Between Inflammatory Bowel Disease and Premature Births

By Dani K. Dodge Medlin, @DaniDodgeMedlin

March 26, 2014

Pregnant woman talking to woman in a suit looking at a paper clipboard

Pregnant women who suffer from inflammatory bowel disease, also known as IBD, are at higher risk of premature labor and other pregnancy complications, according to a study by Kaiser Permanente researchers published last week in the Journal of Perinatology. The severity of that risk, though, can depend on the subtype of the disease, most commonly Crohn’s disease or ulcerative colitis.

“Fortunately, women who have their disease under control by medical or surgical treatment have a lower risk of pregnancy complications,” said lead researcher Darios Getahun, MD, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation.

Dr. Getahun and other researchers from Kaiser Permanente Southern California reviewed the medical records of 444,659 women who delivered in Kaiser Permanente Southern California facilities between 2000 and 2012 to learn new information about the impact of inflammatory bowel disease on pregnancy. And while the researchers found some pregnancy complications were higher for women with inflammatory bowel disease than women without the condition, those complications were still rare.

Pregnancy complications can vary
The study, “Inflammatory Bowel Disease and Adverse Perinatal Outcomes,” found:

  • Pregnancy complications associated with inflammatory bowel disease include higher incidences of:
    • Reduced blood vessel development in the placenta
    • Deprivation of oxygen in the fetus, or fetal hypoxia
    • Spontaneous premature labor
    • Spontaneous preterm rupture of membranes (the membrane sac holding the baby breaks prior to the onset of labor)

Another important finding of the study was that the impact of inflammatory bowel disease on pregnancy depends on the subtype: Only ulcerative colitis was significantly associated with spontaneous premature labor and spontaneous premature rupture of membranes. The research suggests that since an increased risk of pregnancy complications occurs in both Crohn’s disease and ulcerative colitis, the two conditions could play overlapping roles in pregnancy complications.

Inflammatory bowel disease is a chronic or recurring inflammation of the gastrointestinal tract. Symptoms vary but can include bloody stools, diarrhea, abdominal pain and cramping.

Inflammation caused by immune system
In both ulcerative colitis and Crohn’s disease, the immune system attacks the cells of the intestines when it mistakes food and bacteria in the intestine as foreign substances, although the areas of the digestive tract affected, and the impact upon the digestive tract can be different.

The Centers for Disease Control and Prevention estimate that as many as 1.4 million people in the U.S. suffer from inflammatory bowel disease. The Kaiser Permanente research showed that 130 out of 100,000 pregnant women carrying only one child have inflammatory bowel disease.

Ideally, women with inflammatory bowel disease should work closely with their gastroenterologist and obstetrician to develop a treatment plan for pregnancy, said Michael J. Fassett, MD, a specialist in high-risk pregnancies at the Kaiser Permanente West Los Angeles Medical Center and a co-author on the study.

“To have a healthy baby, you first need a healthy mom,” Dr. Fassett said.

Women with IBD can make a plan before pregnancy
Most medications used in the treatment of inflammatory bowel disease are safe for use during pregnancy, he added. And women should be encouraged to follow the treatment plan outlined by their clinicians in order to avoid or reduce symptoms during pregnancy.

“It is much easier to go into a pregnancy with symptoms of the disease under control,” Dr. Fassett said, “than to treat symptoms of a bad flare-up during pregnancy.”

In addition to Dr. Getahun and Dr. Fassett, authors of this study were George F. Longstreth, MD, Corinna Koebnick, PhD, Annette M. Langer-Gould, MD, PhD, Daniel Strickland, MSPH, PhD, and Steven J. Jacobsen, MD, PhD, of the Department of Research & Evaluation, Kaiser Permanente Southern California in Pasadena.