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PREGNANCY OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: RETROSPECTIVE DATA FROM A GREEK NATIONAL REGISTRY

Evgenia Papathanasiou 1, Georgios Kokkotis 2, George Axiaris 1, Nikos Viazis 3, Olga Giouleme 4, Theodoros Argyropoulos 5, Anthia Gatopoulou 6, Aggelos Theodoulou 7, Georgios Theocharis 8, Angeliki Theodoropoulou 9, Maria-Styliani Kalogirou 4, Pantelis Karatzas 10, Konstantinos H. Katsanos 11, Konstantinos Karmiris 9, Anastasia Kourikou 12, Ioannis Koutroubakis 13, Christos Liatsos 14, Gerassimos J. Mantzaris 3, Nicoletta Mathou 15, Georgia Bellou 16, Georgios Michalopoulos 17, Ioannis Tyrmpas 18, PINELOPI NICOLAOU 9, Michael Economou 19, Dimitrios Polymeros 20, Georgios Papatheodoridis 10, Evdoxia Stergiou 21, Konstantinos Soufleris 21, Epameinondas Skouloudis 17, Maria Tzouvala 16, Georgia Tsiolakidou 22, Eftychia Tsironi 7, Styliani Tsafaraki 19, Kalliopi Foteinogiannopoulou 13, Konstantina Chalakatevaki 2, Angeliki Christidou 3, Dimitrios K. Christodoulou 11, Giorgos Bamias 2, Spyridon Michopoulos 1, Evanthia Zampeli 1

Affiliations

1 "Alexandra" General Hospital, Athens, Greece

2 National and Kapodistrian University of Athens, Athens, Greece

3 Evangelismos Hospital, Athens, Greece

4 Hippocration Hospital- Aristotle University School of Medicine, Thessaloniki, Greece

5 General Hospital of Athens Korgialeneio Mpenakeio Hellenic Red Cross, Athens, Greece

6 General University Hospital of Alexandroupolis, Alexandroupoli, Greece

7 Metaxa Memorial General Hospital, Athens, Greece

8 University Hospital of Patras, Patra, Greece

9 Venizeleion Hospital, Heraklion, Crete, Greece

10 Medical School of National and Kapodistrian University of Athens School of Health Sciences- General Hospital of Athens "Laiko"- Athens- Greece, Athens, Greece

11 Gastroenterology Unit University Hospital, Ioannina, Greece

12 Hippokratio General Hospital, Athens, Greece

13 University Hospital of Heraklion- Medical School University of Crete, Heraklion- Crete, Greece

14 401 Army General Hospital of Athens, Athens, Greece

15 'Konstantopoulio-Patission' General Hospital, Athens, Greece

16 General Hospital Nikaias-Piraeus 'Agios Panteleimon'-General Hospital Dytikis Attikis "Agia Varvara"- Athens- Pireaus- Greece, Athens, Greece

17 Tzaneion General Hospital, Athens, Greece

18 Chania General Hospital, Chania, Greece

19 Euroclinic Group, Athens, Greece

20 Medical School- National and Kapodistrian University of Athens- Attikon University General Hospital- Athens, Hepatogastroenterology Unit, Athens, Greece

21 Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece

22 General Hospital Of Kavala, Greece, Kavala, Greece

Summary

AI Generated

A Greek national retrospective study of 223 pregnancies in 175 IBD patients found that the majority had favorable outcomes, though active inflammation during gestation and ulcerative colitis diagnosis were associated with negative impacts on pregnancy outcomes.

Among 223 pregnancies in IBD patients, 99.1% resulted in uncomplicated delivery, with two late fetal deaths (0.9%) both occurring in patients with continuously active disease since the beginning of pregnancy.
IBD flares occurred in 22% of pregnancies, with patients with ulcerative colitis at greater risk of disease flare during pregnancy (p<0.001) compared to those with Crohn's disease.
At the beginning of gestation, 74% of patients were under treatment including anti-TNF agents (29%), azathioprine (26%), 5-aminosalicylic acid formulations (61%), and steroids (7%).
After delivery, 34% of patients presented with a disease flare, which was associated with active disease at the beginning of pregnancy (p<0.001).
The authors conclude their results favor the continuation of IBD treatment during pregnancy, and that close multidisciplinary follow-up of pregnant IBD patients improves maternal and neonatal outcomes.

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Abstract

Introduction

Inflammatory bowel disease (IBD) commonly affects female patients of reproductive age, making the interaction between fertility, pregnancy and IBD an important issue in disease management. The effect of disease activity on the outcome of pregnancy and its impact on neonatal growth is a field of intense research. Close follow-up of pregnant IBD patients by a multidisciplinary team improves maternal and neonatal outcomes.

Aims & Methods

Α national retrospective study of pregnancies in women with IBD between 2010-2020 was carried out in 22 IBD reference centers in Greece. Patient characteristics such as disease profile, type of treatment, and disease activity during gestation were analyzed in correlation to the method of delivery, pregnancy outcomes, as well as breastfeeding and offspring health.

Results

Two-hundred and twenty-three pregnancies in 175 IBD patients were registered in the study. 122 with Crohn’s disease (CD). Median age during diagnosis was 25.6 years (12-44) with median disease duration of 7.4 years (0-23). One-hundred and twenty-nine patients (58%) were recorded during their first pregnancy. Early pregnancy termination was reported by 48 patients (22%). Pregnancy as a result of in vitro fertilization (IVF) occurred in 15 cases (6.7%). At the beginning of gestation 165 patients (74%) were under treatment: 48 with anti-TNF agents (29%), 43 with azathioprine (26%), 101 with 5-aminosalicylic acid formulations (61%) and 12 with steroids (7%). We recorded 49 cases of IBD flares (22%) during pregnancy. Two-thirds of them (n=30) were in remission at the onset of the pregnancy. Almost half of them (n=22) required corticosteroid treatment. Patients with ulcerative colitis (UC) were in greater risk of disease flare during pregnancy (p<0.001). All but 3 pregnancies (99.1%) resulted in uncomplicated delivery. In 147 cases (67.1%) cesarean delivery was performed. Two late fetal deaths (0.9%) were reported, both in patients with continuously active disease since the beginning of pregnancy. After delivery, 75 patients (34%) presented with a disease flare, which was associated with active disease at the beginning of pregnancy (p <0.001).
Table 1. Demographics and characteristics of the cohort

Mean age of diagnosis (years)	25.6 (12-44)
Crohn’s Disease n (%) L1 L2 L3 B1 B2 B3 P	122 (54.7) 41 10 70 76 31 15 24
Ulcerative colitis n (%) E1 E2 E3	101 (45.3) 15 44 41
Smokers n (%) Smoking during pregnancy n (%)	104 (46.6) 31 (14)
Median disease duration (years)	7.4 (0-23)
History of surgery n (%) Right hemicolectomy n (%) Enterectomy n (%) ΙPAA n (%) Perianal surgery n (%)	41 (18.3) 19 (9.4) 6 (3) 2 (1) 14 (7)
Extraintestinal manifestations n (%) Arthritis n (%) Psoriasis n (%) Uveitis n (%)	85 (38.1) 58 (26) 19 (9) 7 (3)
Median age at conception (years)	33
In vitro fertilization n (%)	15 (6.7)
Use of contraceptives n (%)	39 (17.5)

Conclusion

The majority of female, Greek IBD patients, had a favorable pregnancy outcome. Active inflammation during gestation and UC diagnosis were associated with a negative impact on pregnancy outcomes. The results of this study are in favor of the continuation of IBD treatment during pregnancy.
This study was funded by a research grant 2020EOMIFNEmp1 from the Hellenic Group for the Study of IBD (EOMIFNE)

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Nurses

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Optimised management of severe acute autoimmune hepatitis: What is the best timing for liver transplantation?

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Affiliations

1 Centre Hépato-Biliaire Paul Brousse, Villejuif, France

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Surgery Radiology & Imaging Immunology Hepatobiliary

Session

Avoid inflammation and intoxication: Management of autoimmune and alcohol-related liver disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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1 Geneva University Hospitals, Geneva, Switzerland

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UEG Week Barcelona 2026

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Digestive Oncology Colorectal

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1 University of North Carolina / NCRBSI, London, United Kingdom

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Åsa Frändemark, Ahsen Ustaoglu, Haluk Tarik Kani

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