Ulcerative Colitis in Pregnancy: A Japanese Multicenter Cohort Study Focusing on Their Mutual Influence

Abstract

Objective To investigate the clinical course of ulcerative colitis (UC) during pregnancy, focusing on their mutual influence. Methods We retrospectively reviewed the medical records of 58 patients with UC who had 73 pregnancies and 3 patients with newly developed UC during pregnancy. We recorded the rate of relapse of UC; the relationship between medication use and UC relapse during pregnancy; treatment for relapse; and the incidence of pregnancy, childbirth, and newborn abnormalities. Results UC was in remission at conception in 78% of the patients. The relapse rate during pregnancy was 27.3%, with most relapses occurring during the second and third trimesters. The relapse rate in patients in whom any UC drug had been discontinued was 50%, a rate significantly higher than the 20.5% of patients for whom all medications were continued (p=0.016). Thiopurine was discontinued in 60% (6/10) of patients at conception, and the disease relapsed in 50% (3/6) of the patients. Most relapses were successfully treated with 5-aminosalicylic acid or corticosteroids. UC relapse occurred in 26.1% (18/70) of the patients after delivery, mostly within 2 months. Pregnancy, delivery, or neonatal abnormalities occurred in 23.3% (17/73) of patients. In two of the three patients with new-onset UC, UC was severe and required intensive care; however, the pregnancies continued uneventfully. Conclusion Although the progress of pregnancies complicated by UC was mostly uneventful, discontinuing medication carries the risk of UC relapse. Thus, appropriate management of medical treatments for UC during pregnancy is important.

Keywords: pregnancy; pregnancy-onset; relapse; ulcerative colitis.

Figure 1.

The rate of UC relapse during pregnancy. a: The relapse rates by disease activity at conception. b: The relapse rates by grade of activity in cases with active UC at conception.

Figure 2.

Intervals from withdrawal of each medicine to relapse. 5-ASA: 5-aminosalicylic acid, AZA: azathioprine, SP: suppository