A0383 - Impact of Biologics Therapy on the Prevalence of Pregnancy Complications Among Women With Inflammatory Bowel Disease: A Nationwide Population-Based Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmed Eltelbany, MD, MPH

Cleveland Clinic
Cleveland, OH

Ahmed Eltelbany, MD, MPH¹, Khaled Alsabbagh Alchirazi, MD¹, Osama Hamid, MD, MRCPI¹, George Khoudari, MD², Miguel Regueiro, MD³
¹Cleveland Clinic, Cleveland, OH; ²Georgetown University Hospital, Arlington, VA; ³Cleveland Clinic Main Campus, Cleveland, OH

Introduction: Inflammatory bowel disease (IBD) typically coincides with childbearing years in women. IBD has been established as an independent risk factor for pregnancy complications (PC) and adverse pregnancy outcomes. Biologics have been shown to decrease inflammation among IBD patients however its implications on pregnancy outcomes remain unclear. We sought to compare the prevalence of PC among individuals with or without IBD and to assess whether the risk of PC among patients with IBD is altered by biologics therapy.

Methods: We used the IBM Explorys clinical database which includes over 74 million de-identiﬁed unique patients across 300 hospitals in the United States. Patient were identiﬁed using SNOMED and ICD codes. We included female patients in childbearing age between 18 – 50 years, with history of pregnancy and diagnosis of either Crohn’s disease (CD) or ulcerative colitis (UC). We investigated the prevalence of PC in IBD patients compared to patients with no IBD. PC included pre-eclampsia, pre-term labor and miscarriages. Also, we compared the prevalence of PC in IBD patients who received biologics therapy against other treatment modalities. Odds ratios with 95% conﬁdence intervals were calculated to evaluate the risk of pregnancy complications.

Results: Among our cohort of women with history of pregnancy, we identified 23,830 patients with CD and 19,220 patients with UC, of whom 6,550 (27.5%) and 5,520 (28.7%) developed PC, respectively compared to 18.8% in women without IBD, p< 0.0001 to all. Both CD [OR: 1.64; 95% CI: 1.59 – 1.69] and UC [OR: 1.74; 95%CI: 1.69 – 1.80] patients had a significant higher risk of PC compared to patients without IBD. 2,870 (12.0%) patients with CD and 1,520 (7.9%) patients with UC received biologics therapy. Sub-group analysis of the biologics-treated cohort was associated with a significantly lower risk of developing PC in CD [OR: 0.87; 95%CI: 0.79 – 0.95] and UC [OR: 0.81; 95%CI: 0.72 – 0.92], respectively (Figure 1).

Discussion: In this large retrospective study, we found that the prevalence of pregnancy complications in women with IBD was significantly higher than the general population. Furthermore, we found that IBD patients treated with biologics were significantly less likely to be associated with pregnancy complications. Further studies are required to determine whether biologics therapy may mitigate pregnancy complications risk.

Figure: Figure 1: Logistic Regression of pregnancy complications risk in IBD, IBD; inflammatory bowel disease. Immunomodulators included azathioprine, methotrexate and mercaptopurine. Other biologics included natalizumab, ustekinumab and vedolizumab. TNF-a Blockers; tumor necrosis factor-alpha blocker.

Variable	Patients with Pregnancy Complications		No Pregnancy Complications N=2,413,580 (%)
Variable	With IBD N=8,210 (%)	Without IBD N=552,000 (%)	No Pregnancy Complications N=2,413,580 (%)
Age >35	4960 (60.4%)	333,810 (60.5%)	1,322,060 (54.8%)
Caucasian	6,460 (78.7%)	337,470 (61.1%)	1,386,960 (57.5%)
Smoker	2,180 (26.6%)	72,990 (13.2%)	222,460 (9.2%)
Alcohol Abuse	230 (2.8%)	12630 (2.3%)	35,300 (1.5%)
T2DM	610 (7.4%)	32,660 (5.9%)	82,280 (3.4%)
Hyperlipidemia	1,680 (20.5%)	43,590 (7.9%)	125,010 (5.2%)
HTN	280 (3.4%)	13,460 (2.4%)	28,800 (1.2%)
CAD	580 (7.1%)	3,870 (0.7%)	13,860 (0.6%)
Obesity	4,750 (57.9%)	127,470 (23.1%)	355,890 (14.7%)
Intestinal Resection	880 (10.7%)	7,410 (1.3%)	24,130 (1.0%)
Colectomy	540 (6.6%)	6,170 (1.1%)	20,350 (0.8%)
Pre-eclampsia	1,570 (19.1%)	113,220 (20.5%)	NA
Pre-term Labor	2,910 (35.4%)	116,860 (21.2%)	NA
Miscarriage	4,930 (60.0%)	365,420 (66.2%)	NA

Table: Demographics of patients with IBD and PC. IBD; inflammatory bowel disease, PC; pregnancy complications, T2DM; type 2 diabetes mellitus; HTN; hypertension, CAD; coronary artery disease.

Disclosures:

Ahmed Eltelbany indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Osama Hamid indicated no relevant financial relationships.

George Khoudari indicated no relevant financial relationships.

Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant. Abbvie – Grant/Research Support. ALFASIGMA, S.p.A. – Advisory Committee/Board Member. Allergan – Advisory Committee/Board Member. Amgen – Advisory Committee/Board Member. BMS – Grant/Research Support. Bristol Meyer Squibb – Advisory Committee/Board Member, Consultant. CC360 – Royalties. Celgene – Advisory Committee/Board Member. CME Outfitters – CME Companies. Cornerstones – CME Companies. Crohn’s and Colitis Foundation as Editor-in-Chief – Royalties. Genentech – Advisory Committee/Board Member. Genentech – Grant/Research Support. Gilead – Advisory Committee/Board Member. Gilead – Grant/Research Support. HMPGlobal – CME Companies. Imedex, GI Health Foundation (GiHF) – CME Companies. Janssen – Advisory Committee/Board Member, Consultant. Janssen – Grant/Research Support. Lilly – Grant/Research Support. MDEducation – CME Companies. Medscape – CME Companies. Miraca Labs – Advisory Committee/Board Member. MJH life sciences – CME Companies. Pfizer – Advisory Committee/Board Member, Consultant. Prometheus – Advisory Committee/Board Member. Remedy – CME Companies. Salix – Advisory Committee/Board Member. Seres – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Consultant. TARGET Pharma Solutions – Advisory Committee/Board Member. UCB – Grant/Research Support. WebMD – CME Companies. Wolters Kluwer Health as Author/Editor of UpToDate – Royalties.

Ahmed Eltelbany, MD, MPH¹, Khaled Alsabbagh Alchirazi, MD¹, Osama Hamid, MD, MRCPI¹, George Khoudari, MD², Miguel Regueiro, MD³. A0383 - Impact of Biologics Therapy on the Prevalence of Pregnancy Complications Among Women With Inflammatory Bowel Disease: A Nationwide Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.