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Neonatal and Pregnancy Outcomes in Pregnant Adults With Pediatric-Onset Crohn's Disease
Supraja Swamy1, Jean-Paul Achkar2, Stacey Ehrenberg3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist University, Winston-Salem, North Carolina.
Insights
Women diagnosed with Crohn's disease (CD) in childhood have better neonatal outcomes. Maintaining disease control during pregnancy is key for improving birth weight (BW) and gestational age (GA) in infants born to mothers with CD.
Area of Science:
- Reproductive Medicine
- Pediatric Gastroenterology
- Obstetrics
Background:
- Crohn's disease (CD) in pregnancy can lead to low birth weight (BW) and preterm birth.
- Limited data exists on pregnancy and neonatal outcomes for individuals diagnosed with CD during childhood or adolescence.
- Understanding the impact of maternal age at CD diagnosis is crucial for optimizing pregnancy care.
Purpose of the Study:
- To evaluate the relationship between maternal age at Crohn's disease (CD) diagnosis and pregnancy and neonatal outcomes.
- To compare gestational age (GA) and birth weight (BW) in infants born to mothers with pediatric-onset versus adult-onset CD.
- To identify factors influencing neonatal outcomes in pregnancies affected by CD.
Main Methods:
- Retrospective, cross-sectional study of women with CD who delivered between 2012 and 2023.
- Analysis of gestational age (GA) and birth weight (BW) as primary outcomes.
- Comparison of outcomes based on maternal age at CD diagnosis (pediatric vs. adult onset).
Main Results:
- No significant difference in gestational age (GA) at delivery between groups.
- Higher rate of small-for-GA neonates born to mothers with adult-onset CD (15.9%) compared to pediatric-onset CD (3.8%).
- Increased birth weight (BW) percentiles associated with anti-TNF therapy; CD flares negatively impacted BW percentiles.
Conclusions:
- Neonates born to mothers with pediatric-onset Crohn's disease (CD) show excellent gestational age (GA) and birth weight (BW) outcomes.
- Longer disease duration and anti-tumor necrosis factor therapy positively correlate with improved BW percentiles.
- Disease control during pregnancy is more impactful on neonatal outcomes than age at diagnosis or disease duration.
Background And Aims:
Low birth weight (BW) and preterm birth are recognized complications in women with active Crohn's disease (CD). However, there is limited information on pregnancy and neonatal outcomes in patients diagnosed during childhood and adolescence. This study aims to evaluate the relationship between maternal age at CD diagnosis and pregnancy and neonatal outcomes.
Methods:
We conducted a retrospective, cross-sectional study of women with CD who delivered between 2012 and 2023. Gestational age (GA) at delivery and (BW) were analyzed as coprimary outcomes.
Results:
A total of 262 births from 179 mothers were included, with 105 (40.1%) births from women diagnosed with CD before age 18. No significant differences were observed in GA at delivery between groups. There was a significantly higher rate of neonates born small for GA to mothers with adult-onset CD compared with pediatric-onset CD (15.9% vs 3.8%, P = .002). The odds of delivering a small-for-GA infant decreased by 21% for every 10% increase in the proportion of a woman's life spent living with CD (95% confidence interval [CI]: 0.65-0.96). A CD flare during pregnancy resulted in a 10.9% reduction in BW percentile at delivery (95% CI: -20.05 to -1.64). Antitumor necrosis factor therapy at the time of conception was associated with an 8.7% increase in BW percentiles (95% CI: 1.13-16.27).
Conclusion:
Neonates born to women with pediatric-onset CD have excellent outcomes including GA and BW percentiles at delivery. Longer disease duration and antitumor necrosis factor therapy were positively associated with improved BW percentiles, while disease activity had a negative impact. These findings suggest that disease control has a more significant impact on neonatal outcomes than age of onset or disease duration.
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