Importance of appropriate pharmaceutical management in pregnant women with ulcerative colitis

Abstract

Background: Ulcerative colitis (UC) often occurs in women of childbearing age. Compared to Western countries, however, few studies have investigated the impact of UC on the progress of pregnancy in Asian populations.

Methods: We retrospectively examined 91 pregnancies in 64 patients with UC experienced at our hospital and related institutions from 1991 to 2011, focusing on the relationship between the progression of UC during pregnancy, progress of the pregnancy itself, and the treatment of UC.

Results: In 80 of 91 pregnancies the patient had already been diagnosed with UC at the time she became pregnant, of whom 31 (38.8%) experienced exacerbation during pregnancy. Regarding severity, moderate or severe active-stage disease during pregnancy was seen in 13.7% of those who had been in remission at the onset of pregnancy versus 58.6% of those who had been in the active stage at onset (OR 8.9: 95%CI 3.0~26.4; P<0.01). The incidence of miscarriage or abortion was 9.8% in pregnancies in which UC was in remission at onset versus 31% in those in which it was in the active stage at onset (OR 4.1: 95%CI 1.2~13.9; P=0.02). Among patients, 62.5% were receiving pharmaceutical treatment at onset of pregnancy. Exacerbation during pregnancy occurred in 26.5% of the group who continued to receive the same treatment during pregnancy versus 56.3% of those with a dose decrease or discontinuation after onset (OR 3.6: 95%CI 1.0~12.4; P=0.04).

Conclusions: UC patients wishing to conceive should do so when in remission and continue appropriate pharmaceutical treatment during pregnancy.

Figure 1

Schema of the severity at the onset of pregnancy and change in severity during pregnancy. Green squares indicate UC diagnosis and status at the onset of pregnancy, and blue squares indicate UC status during pregnancy. Cases experiencing exacerbation are shown in red.

Figure 2

Schema of the frequency of exacerbation of UC during pregnancy by approach to treatment. Green squares indicate UC treatment at the onset of pregnancy, and blue squares indicate UC treatment during pregnancy. Cases experiencing exacerbation are shown in red.

Figure 3

Exacerbation rate of UC by approach to treatment. Exacerbation rate was significantly higher in patients whose doses were reduced or whose treatment was discontinued than in those who continued pharmaceutical treatment.

Figure 4

Exacerbation rate in patients in remission at the onset of pregnancy by approach to treatment.