Gestational Weight Gain: A New Factor Influencing Pregnancy Outcomes in Women with Inflammatory Bowel Disease

Excerpt

Crohn’s disease (CD) and ulcerative colitis (UC) are associated with adverse pregnancy outcomes, including preterm birth, small for gestational age, congenital anomalies, and stillbirths [1]. Increased disease activity during pregnancy, which is particularly worrisome, is linked to preterm birth [2]. Multiple studies of immunosuppressive medication use during pregnancy have reported that thiopurines and biologic therapies have no impact on birth outcomes [3, 4]. Nevertheless, is it only increased disease activity that physicians and patients need to be wary of? Or are there other pregnancy factors associated with adverse outcomes? Women with inflammatory bowel disease (IBD) often suffer from weight loss and malnutrition, both of which may impact a potential pregnancy. In this issue of Digestive Disease and Sciences, Bengtson et al. [5] investigated the effect of gestational weight gain (GWG) on birth outcomes using the large US Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort of women with IBD during pregnancy. The PIANO cohort consists of 559 and 363 pregnant mothers with CD and UC, respectively, enrolled between 2006 and 2014. The authors used the Institute of Medicine guidelines for GWG according to pre-pregnancy body mass index. The problematic part of this paper was the measurement of disease activity. In the PIANO registry, measurements of the Harvey–Bradshaw Index for CD and Simple Clinical Colitis Index for UC were performed at each trimester. These scales, however, have not been validated for pregnant subjects; furthermore, the authors do not report corroborating fecal calprotectin concentrations. Although disease activity was also measured by the number of hospitalizations and intensification of medical therapy and/or surgery, these results were not reported. …