Epidemiology and Treatment of Inflammatory Bowel Disease in Pregnancy: Results from a Retrospective, Observational...

Inflammatory bowel disease (IBD) can adversely affect conception and pregnancy outcomes. Disease management must balance the benefits and risks for both mother and foetus.

To investigate real-world pregnancy incidence and treatment patterns among women with IBD.

This retrospective, observational study used data from the Merative^TM MarketScan® Commercial and Multi-state Medicaid Databases and included women aged 15-44 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). The incidence analysis also included a non-IBD cohort matched 2:1 to patients in the IBD cohort. The treatment pattern analysis included women with a pregnancy occurring on or after January 1, 2017. Primary outcomes were pregnancy incidence for women with IBD vs. matched non-IBD controls, and IBD medications among pregnant women.

Among 59,652 patients with CD and 50,452 patients with UC, pregnancy incidence was lower for patients with IBD vs. non-IBD matched controls (incidence rate ratio [95% confidence interval]: CD, 0.78 [0.76, 0.80]; UC, 0.76 [0.74, 0.78]). Treatment patterns were assessed among 3862 and 3269 pregnancies from 3235 and 2785 patients with CD and UC, respectively. Medication use was generally lower during pregnancy vs. before or after pregnancy. The most common medications were biologics for CD (23.6-34.1% across trimesters) and aminosalicylates for UC (25.0-34.9%). Pre-conception counselling and IBD-related surgery/hospitalisation were associated with increased biologic use during pregnancy.

Patients with vs. without IBD had lower rates of pregnancy. Treatment patterns in recent years reflect current guidelines for IBD management during pregnancy. Pre-conception counselling should be emphasized.