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IBD patients generally have good perinatal outcomes. (Higher C-Section Rate).

SAN FRANCISCO -- Pregnant women with inflammatory bowel disease were more likely to have a cesarean section than those without the disease, but perinatal outcomes were similar between groups in a retrospective chart review.

In a study of women with singleton pregnancies delivered at Mt. Sinai Hospital, New York, between 1986 and 2001, investigators compared data on 116 women with inflammatory bowel disease (IBD) and 56,398 control subjects without the disease. The pregnancies studied were the most recent for each patient.

The IBD patients were more likely to have had a C-section than were controls (32% vs. 22%), Dr. Shefali Patel said during the annual meeting of the Society for Maternal-Fetal Medicine.

The higher C-section rate was due to an increase in elective C-sections in the IBD patients, according to an analysis that controlled for race, insurance status, maternal age, smoking status, and induction of labor.

There were no differences between groups in postpartum or neonatal complications, and no differences in antepartum hyperemesis, preterm labor, or preeclampsia. Maternal weight gain, obesity, hypertension, and alcohol use did not differ between groups.

"Overall, our study documents good perinatal outcomes for patients with IBD," said Dr. Patel of Mount Sinai School of Medicine, New York.

The peak incidence of IBD overlaps with a woman's reproductive years, but few data exist on the course and management of IBD in pregnancy. Some studies have suggested an increased risk for preterm deliveries, low birth weight, or C-section in women with IBD. Most studies did not separate IBD patients by subgroups, as the current study did.

For example, in the IBD women with ulcerative colitis, 19% of the babies born had low birth weight, compared with none of the babies born to women with Crohn's disease.

This higher risk of low birth weight with ulcerative colitis contradicts some earlier data, perhaps because Mount Sinai Hospital is a large referral center that draws sicker patients.

IBD flared during pregnancy in 22 of the 116 women. Those women had higher rates of preterm delivery (27% vs. 8%) and low birth weight (32% vs. 3%) than did the IBD patients whose disease did not flare during pregnancy.

Although overall outcomes for the IBD women were good, special attention may be needed for women in subgroups with a disease flare or with ulcerative colitis.

Among IBD patients, those who had undergone IBD surgery were more likely to deliver by C-section (44% vs. 27%) and less likely to have a low-birth-weight baby (0% vs. 12%) than those who hadn't undergone such surgery, Dr. Patel said at the meeting.

The better birth weights in women with prior surgery perhaps could be due to surgical cure of ulcerative colitis, better nutritional status, and disease quiescence, Dr. Patel suggested.

Compared with control subjects, the IBD patients had higher rates of labor induction (24% vs. 32%) and chorioamnionitis (3% vs. 7%).

The mean ages of the IBD patients and control subjects were 33 and 31 years, respectively.
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Author:Boschert, Sherry
Publication:OB GYN News
Date:Apr 15, 2003
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