Targeted and regular outpatient care before conception helped prevent relapse of inflammatory bowel disease (IBD) during pregnancy, according to a single-center prospective observational study reported in the September issue of Clinical Gastroenterology and Hepatology.
Women who received such care had about 50% lower odds of relapse while pregnant compared with women seen only after conception, said Alison de Lima, MD, PhD, of Erasmus MC–University Medical Hospital Rotterdam (the Netherlands) and her associates. “Preconception care seems effective in achieving desirable behavioral modifications in IBD women in terms of folic acid intake, smoking cessation, and correct IBD medication adherence, eventually reducing disease relapse during pregnancy. Most importantly, preconception care positively influences birth outcomes,” the investigators concluded.
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Several recent studies have reported “incorrect beliefs, unfounded fears, and insufficient knowledge” among women with IBD when it comes to pregnancy, the researchers noted. These beliefs can undermine medication adherence, potentially increasing the risk of complications and poor birth outcomes, they added. Studies have confirmed the value of preconception care for chronic diseases such as diabetes, but none had done so for IBD (Clin Gastroenterol Hepatol. 2016 Mar 18. doi: 10.1016/j.cgh.2016.03.018). Therefore, Dr. de Lima and her associates prospectively followed 317 women seen at the IBD preconception outpatient clinic at a tertiary referral hospital during 2008-2014. A total of 155 patients first visited the clinic before becoming pregnant, while the other 162 patients did so only after conception. New patient visits lasted about 30-45 minutes and included fecal calprotectin testing to assess disease activity, education about the need to avoid conceiving during a disease flare, and general advice about taking folic acid, quitting smoking, and avoiding alcohol during pregnancy. Follow-up visits, which occurred every 3 months before pregnancy and every 2 months thereafter, included clinical assessments of disease activity, maternal serum testing to assess compliance with antitumor necrosis factor and thiopurine therapy, and assessments of folic acid supplementation, smoking, and alcohol use.
Patients who received such care before conceiving tended to be younger (29.7 vs. 31.4 years; P = .001), were more often nulliparous (76% vs. 51%; P = .0001), and had a shorter history of IBD (5.1 vs. 8 years; P = .0001), compared with the postconception care group, the researchers said. However, after researchers controlled for parity, disease duration, and the number of relapses in the year before pregnancy, the preconception care group had a nearly sixfold greater odds of adhering to IBD medications during pregnancy (adjusted odds ratio, 5.7; 95% confidence interval, 1.9-17.3), about a fivefold greater odds of sufficient folic acid intake (aOR, 5.3; 95% CI, 2.7-10.3), and a more than fourfold odds of smoking cessation during pregnancy (aOR, 4.63; 95% CI, 1.2-17.6). Notably, preconception care was tied to a 49% lower odds of disease relapse during pregnancy (aOR, 0.51; 95% CI; 0.28-0.95) and to a nearly 50% lower rate of low birth weight (birth weight less than 2,500 g).
“To our surprise, this study did not detect an effect of preconception care on periconceptional disease activity,” the researchers said – even though they strove to educate patients on this concept. “We can only speculate about the explanation for this finding, but we believe this could be a result of a discrepancy between physician-declared disease remission and the patient’s own feeling of well-being combined with a strong reproductive desire.”
The investigators reported no funding sources, and Dr. de Lima had no disclosures. Two coinvestigators reported ties to Merck Sharp & Dohme, Abbott, Shire, and Ferring.