Ulcerative Colitis in Pregnancy: A Japanese Multicenter Cohort Study Focusing on Their Mutual Influence

Area of Science:

• Gastroenterology
• Obstetrics
• Pharmacology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Pregnancy in women with UC requires careful consideration of disease activity and treatment.
• Understanding the interplay between UC and pregnancy is essential for optimal patient care.

Purpose of the Study:

• To investigate the clinical course of ulcerative colitis (UC) during pregnancy.
• To assess the influence of UC on pregnancy and vice versa.
• To evaluate the impact of medication management on UC relapse rates during pregnancy.

Main Methods:

• Retrospective review of medical records for 58 patients with UC and 73 pregnancies.
• Inclusion of 3 patients with new-onset UC during pregnancy.
• Data collection on UC relapse rates, medication use, treatment, and pregnancy/neonatal outcomes.

Main Results:

• 78% of patients had UC in remission at conception.
• 27.3% relapse rate during pregnancy, predominantly in the second and third trimesters.
• Discontinuing UC medication led to a 50% relapse rate, significantly higher than the 20.5% in those continuing medication (p=0.016).
• Postpartum UC relapse occurred in 26.1% of patients within 2 months.
• Pregnancy, delivery, or neonatal abnormalities were observed in 23.3% of cases.
• New-onset UC during pregnancy was severe in 2 out of 3 cases but pregnancies continued uneventfully.

Conclusions:

• Pregnancy progression is generally uneventful in most patients with UC.
• Discontinuing UC medication significantly elevates the risk of disease relapse.
• Appropriate medical management of UC during pregnancy is critical for favorable outcomes.