World Congress of Gastroenterology

WCOG 2019


 
Immunosuppressants and Pregnancy in Inflammatory Bowel Disease
KECILI LINDA 1 KADDACHE NADJIB 1 BOUNAB NASSIMA 1 BOUCEKKINE TADJEDDINE 1 BELHOCINE KAFIA 1 GAMAR LEILA 1 LAYAIDA KARIM 1 BERKANE SAADI 1

1- Gastroenterology CHU Mustapha Algiers Algeria
 
Background/Aims:

 Immunosuppressive (IS) prescription in a pregnant patient with Inflammatory Bowel Disease (IBD) is currently considered safe for the mother, the fetus and the long-term course of the disease. However, this assertion is based on few, small, and often retrospective studies.

Materials and Methods:

 261 consecutive patients with IBD were followed prospectively between 1/1/2005 and 31/12/2009: 224 of them were pregnant or had pregnancies (Group I: GI) and 37 had never had a pregnancy (Group II: GII); 37 patients (30 of GI and 7 of GII), including 19 Ulcerative colitis (UC) and 18 Crohns Disease (CD), received IS at baseline (Azathioprine AZT: 2.5 mg / kg / d) for one duration of 29 to 36 months (duration of treatment = 29 to 36 months). In the GI, the indication of IS was mainly corticodependence (UC: 81.2%, CD: 78.6%). In the GII, the IS were administered in the UC as maintenance treatment in relapse of severe acute colitis (66.6%) more rarely for corticodependence (33.3%). In CD, AZT was prescribed for anoperineal involvement (50%) or corticodependence (50%). The evaluation is based on the last pregnancy under IS and on its follow-up. Statistics: Student Fisher t-tests and Mann Whitney U-tests.

Results:

 The comparison of the IBD / GI / IS + and IBD / GI / IS- groups shows no statistically significant difference (DSS) in terms of demographics, gestational status of the patients, and general and progressive disease characteristics of the disease. It is same in the UC / GI / IS + and UC / GI / IS-. In contrast, patients in the CD / GI / IS + group differed from CD / GI / IS- patients by a greater prevalence of anorectal (27.7% Vs 17.5%) and proximal (11.1% Vs 0%) ). Compared to that of the IBD / GI / IS- patients, the overall fetal prognosis of IBD / GI / IS +, is characterized by a higher frequency of caesarean section (13.3% vs 8.7% p <0.05) of death in utero (3.3% Vs 1.5% p <0.05) and malformations (3.3% Vs 0.5% p <0.05) while the abortion rate (6.6% Vs 5.2% p> 0.05), prematurity (6.6% vs 5.2% p> 0.05) and fetal hypotrophy (10% vs 8.2% p> 0.05) were identical rates in both groups. More precisely, the UC / GI / IS + differs from the UC / GI / IS- only by the more frequent malformation rate in the last group (0% Vs 1%). In CD / GI / IS + the fetal prognosis differs from that of CD / GI / IS- by higher rates of caesarean section (21.4% vs 10.2% p <0.05) of fetal hypertrophy (14 , 2% Vs 8.2% p <0.05) and fetal malformations (7.1% Vs 0% p <0.001). The long-term course of the disease does not show a major difference between IM patients who received ISs and those who did not. The same is true when comparing the IBD / GI / IS + and IBD / GII / IS + group

Conclusion:

 The results of this study are in favor of a slight increase in fetal risk, resulting in an increase in the rate of congenital malformations and hypertrophy, mainly during AZT-treated MC; this risk is not very significant in UC. It is difficult to attribute this effect to AZT, since IS is prescribed in the most severe forms of IBD, the severity of the disease being able to explain, at least in part, the increase in fetal risk. 

Keywords:

 Pregnancy, immunosuppressors, prognosis