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The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Kristel K Leung1,2, Parul Tandon1,2, Vivek Govardhanam1
1Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
Insights
Patients with inflammatory bowel disease (IBD) face higher risks for adverse neonatal outcomes, including low birth weight and intensive care unit admission. Active disease and anti-tumor necrosis factor (anti-TNF) therapy further elevate these risks for expectant mothers.
Area of Science:
- Perinatal medicine
- Gastroenterology
- Immunology
Background:
- Inflammatory bowel disease (IBD) encompasses chronic conditions affecting the gastrointestinal tract.
- Pregnancy in IBD patients presents unique challenges due to potential disease activity and treatments.
- Adverse neonatal outcomes are a significant concern for pregnancies complicated by IBD.
Purpose of the Study:
- To determine the pooled incidences of adverse neonatal outcomes in infants born to mothers with IBD.
- To identify risk factors associated with these adverse outcomes.
- To compare outcomes in IBD patients with those of healthy controls.
Main Methods:
- A systematic literature search was conducted across Medline, Embase, and Cochrane Library up to May 2019.
- Studies reporting adverse neonatal outcomes in IBD patients were included.
- Pooled incidences and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Main Results:
- Pooled incidences: preterm birth (8.6%), low birth weight (8.9%), congenital anomalies (2.1%), and neonatal intensive care unit (NICU) admission (4.9%).
- IBD patients had higher odds of low birth weight (OR, 2.78) and NICU admission (OR, 3.33) compared to controls.
- Active IBD disease and anti-tumor necrosis factor (anti-TNF) therapy were associated with increased risks of preterm birth, low birth weight, and NICU admission.
Conclusions:
- Patients with IBD, especially those with active disease or on anti-TNF therapy, are at increased risk for adverse neonatal outcomes.
- These findings highlight the need for careful monitoring and management during pregnancy for IBD patients.
- Further research may focus on optimizing treatment strategies to mitigate neonatal risks.
Background:
Patients with inflammatory bowel disease (IBD) may be at increased risk of adverse neonatal outcomes. The aim of this study was to determine pooled incidences and risk factors for these outcomes.
Methods:
Medline, Embase, and Cochrane Library were searched through May 2019 for studies reporting adverse neonatal outcomes in IBD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Results:
The pooled incidence of preterm birth, low birth weight, congenital anomalies, and infants transferred to the neonatal intensive care unit was 8.6% (95% CI, 7.0%-10.1%), 8.9% (95% CI, 7.3%-10.5%), 2.1% (95% CI, 1.6%-2.6%), and 4.9% (95% CI, 2.9%-6.9), respectively. Compared with healthy controls, patients with IBD were more likely to deliver infants with low birth weight (<2500 grams; OR, 2.78; 95% CI, 1.16-6.66) and infants admitted to the intensive care unit (OR, 3.33; 95% CI, 1.83-6.05). Patients with Crohn's disease had an increased incidence of congenital anomalies (OR, 3.03; 95% CI, 1.43-6.42). Among IBD patients, active disease was associated with increased incidence of preterm birth (OR, 2.06; 95% CI, 1.21-3.51), low birth weight (OR, 2.96; 95% CI, 1.54-5.70), and small for gestational age (OR, 2.62; 95% CI, 1.18-5.83). Antitumor necrosis factor (anti-TNF) use during pregnancy was associated with an increased incidence of neonatal intensive care unit admission (OR, 2.42; 95% CI, 1.31-4.45) and low birth weight (OR, 1.54; 95% CI, 1.01-2.35).
Conclusions:
Patients with IBD, particularly with active disease or requiring anti-TNF therapy, may be at increased risk of developing adverse neonatal outcomes.
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