Outcomes during delivery hospitalisations with inflammatory bowel disease

Abstract

Objective: To characterise inflammatory bowel disease (IBD) trends and associated risk during delivery hospitalisations.

Design: Cross-sectional.

Setting: US delivery hospitalisations.

Population: Delivery hospitalisations in the 2000-2018 National Inpatient Sample.

Methods: This study analysed a nationally representative hospital discharge database based on the presence of IBD. Temporal trends in IBD were analysed using joinpoint regression to estimate the average annual percent change (AAPC). IBD severity was characterised by the presence of diagnoses such as penetrating and stricturing disease and history of bowel resection. Risks for adverse outcomes were analysed based on presence of IBD. Poisson regression models were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect.

Main outcome measure: Prevalence of IBD and associated adverse outcomes.

Results: Of 73 109 790 delivery hospitalisations, 89 965 had a diagnosis of IBD. IBD rose from 0.06% in 2000 to 0.21% in 2018 (AAPC 7.3%, 95% CI 6.7-7.9%). Among deliveries with IBD, IBD severity diagnoses increased from 4.1% to 8.1% from 2000 to 2018. In adjusted analysis, IBD was associated with increased risk for preterm delivery (aRR 1.50, 95% CI 1.47-1.53), severe maternal morbidity (aRR 1.93, 95% CI 1.83-2.04), venous thrombo-embolism (aRR 2.76, 95% CI 2.39-3.18) and surgical injury during caesarean delivery hospitalisation (aRR 5.03, 95% CI 4.76-5.31). In the presence of a severe IBD diagnosis, risk was further increased for all adverse outcomes.

Conclusion: IBD is increasing in the obstetric population and is associated with adverse outcomes. Risk is increased in the presence of a severe IBD diagnosis.

Tweetable abstract: Deliveries among women with inflammatory bowel disease are increasing. Disease severity is associated with adverse outcomes.

Keywords: inflammatory bowel disease; maternal morbidity; maternal outcomes.