Influence of medical treatment, smoking and disease activity on pregnancy outcomes in Crohn's disease

Abstract

Objective. Little is known about predictors for adverse pregnancy outcomes among women with Crohn's disease (CD). In this population-based study, we examined pregnancy outcomes in CD stratified by medical treatment and smoking status while accounting for disease activity. Methods. In two Danish regions with a population of 1.6 million, we identified 154 CD women who had given birth within a 6-year period. We combined questionnaire data, prescription data, data from medical records and population-based medical databases. We used logistic regression to estimate prevalence odds ratios (POR) for adverse pregnancy outcomes by different predictors. Results. Among 105 (80%) respondents, 55 (52%) reported taking medication during pregnancy. The majority (95%) were in disease remission. The children's mean birth weight did not differ by maternal medical treatment. As expected, smoking was a predictor of low birth weight. Mean birth weight in children of smokers in medical treatment was significantly reduced by 274 g compared with children of non-smokers who received medical treatment. In children of women without medical treatment, this difference was 126 g between smokers and non-smokers. Women in medical treatment did not have an increased risk of preterm delivery (POR 0.71; 95% confidence interval (CI) 0.18–2.79), congenital malformations (POR 0.60; 0.10–3.76) or cesarean section (POR 1.40; 0.63–3.08). Conclusion. In CD, smoking was negatively associated with child birth weight. This association was most pronounced among women who received medical treatment. Maternal medical treatment for CD did not seem to be a risk factor for adverse pregnancy outcomes.

Key Words::

• Crohn's disease
• disease activity
• inflammatory bowel disease
• medical treatment
• pregnancy
• pregnancy outcome
• smoking

Acknowledgments

The authors gratefully acknowledge the physicians at the hospitals involved.

Declaration of interest: Dr. Mette Julsgaard has served as a speaker for AbbVie A/S. Dr. Christian Lodberg Hvas has served as a speaker for AbbVie A/S and MSD A/S. Dr. Lisbet Ambrosius Christensen has served as a speaker for Ferring A/S, MSD A/S, and AbbVie A/S and is a member of the advisory board for MSD A/S. The remaining authors declare no conflicts of interest. This study was funded in part by the Danish Colitis-Crohn association and the A.P. Moeller Foundation of the Advancement of Medical Science. The Danish Ministry of Health has financially supported Dr. Mette Julsgaard. The funding has in no way affected the study design, data collection, analysis and interpretation of the data or the writing of the report.