Fertility Treatment in Inflammatory Bowel Disease
Many women with inflammatory bowel disease (IBD) are of childbearing age, and reproductive concerns are paramount. At this year's Digestive Disease Week, presentations on fertility and pregnancy in women with IBD provided answers to questions about the ability of women with IBD to undergo successful fertility treatment and the safety of continuing IBD treatments throughout pregnancy.
With the understanding that fertility may be impaired in IBD, investigators at the Brigham and Women's and Beth Israel Hospitals in Boston, Massachusetts, studied IBD patients' in vitro fertilization (IVF) rates compared with healthy controls'. Between 1998 and 2011, investigators identified and matched 130 women with IBD to 4 healthy controls on age, parity, and infertility diagnosis. In the IBD group, 35% were pregnant after the first IVF cycle compared with 36% without IBD, for a P value of .83. The live birth rates were similar as well. Of the IBD patients, 20 had undergone J-pouch surgery. The study authors concluded that the ability of women with IBD to become pregnant with IVF is not different from those without IBD. It is very helpful to women with IBD to know that their disease does not appear to impair their ability to conceive and carry a child.
Steroid Exposure in Pregnancy
From the Crohn's and Colitis Foundation of America (CCFA) national pregnancy registry came 3 abstracts this year. In the first, steroid exposure during pregnancy was examined for pregnancy outcomes, both maternal and fetal. Steroid exposure per trimester and the subsequent outcomes at 4, 9, and 12 months of age were recorded. The primary endpoints of interest were infant infection rate and milestone development. The study included 969 women, and although there was an increased trend for infection in the first 4 months of life (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.9-1.7), this did not persist to month 12 when controlled for breastfeeding. There was no correlation between steroid exposure and developmental delay or birth defects. In mothers exposed to steroids, there was an increased risk for gestational diabetes (OR, 2.8; 95% CI, 1.3-6.0) and low birth weight (OR, 2.8; 95% CI, 1.3-6.1); these results controlled for both disease activity and immunomodulator use.