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Meta-Analysis
. 2013 Sep;38(5):460-6.
doi: 10.1111/apt.12417. Epub 2013 Jul 15.

Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease

A Abhyankar  1 , M Ham, A C Moss
Affiliations
Meta-Analysis

Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease

A Abhyankar et al. Aliment Pharmacol Ther. 2013 Sep.

Abstract

Background: The rate of exacerbation of inflammatory bowel disease (IBD) during pregnancy varies in the published literature.

Aim: We sought to perform a systematic review and meta-analysis of the effects of disease activity at conception on disease course during pregnancy in women with IBD.

Methods: Published studies and abstracts from standard sources were screened for appropriate studies. Data were pooled and analysed using funnel and forest plots. Quality assessment scores were given using GRADE criteria.

Results: Fourteen studies were eligible for inclusion; ten studies contained patients with UC (N = 1130), and six studies contained patients with CD (N = 590). In patients with UC there was a significantly higher risk ratio of active disease during pregnancy in patients who commenced pregnancy with active disease (55%), when compared with those in remission at conception (36%) (RR 2.0, 95% CI: 1.5-3, P < 0.001). This risk was also higher in patients with CD (RR 2.0, 95% CI: 1.2-3.4, P = 0.006). Thirteen of the studies rated 'low' in all domains of a quality assessment, and there was significant statistical heterogeneity.

Conclusions: Patients with IBD who conceive when their disease is active are more likely to have active disease during pregnancy than those who conceive when in remission. All studies used in this analysis had a high risk of bias therefore further studies are required.

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Figures

Figure 1
Figure 1
Flow-chart of filtering of search results
Figure 2
Figure 2
Forest plot of meta-analysis of “active disease during pregnancy” according to patients’ disease activity at conception in those with Ulcerative Colitis. The squares and lines represent the effect estimate and confidence intervals for each individual study, and the diamond represents the overall effect estimate for the pooled studies. If the effect estimate is to the right of the vertical line in the forest plot, it means that the “active” group had a higher RR of disease activity (the negative outcome) during pregnancy, so this favors being “inactive” at conception.
Figure 3
Figure 3
Forest plot of meta-analysis of “active disease during pregnancy” according to patients’ disease activity at conception in those with Crohn’s disease.
See this image and copyright information in PMC

Comment in

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