Results from a prospective study published in Gut suggest that exposure to corticosteroids in pregnancy may increase the risk for adverse perinatal outcomes in infants born to mothers with inflammatory bowel disease (IBD). Specifically, prenatal corticosteroid treatment was associated with preterm birth, low birth weight, and newborn intensive care unit (NICU) admission. Corticosteroid use late in pregnancy also increased the risk for severe infant infection requiring hospitalization at 9 and 12 months of age.
Investigators extracted data from the Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes registry, a prospective national United States registry of pregnant individuals with a confirmed diagnosis of IBD. Maternal data were collected at baseline, at the end of each trimester, at delivery, and at 4, 9, and 12 months postpartum. Data of interest included age, race/ethnicity, IBD type, comorbidities, parity, smoking status, and alcohol and illicit drug use. Corticosteroid exposure was defined as oral, enema, or intravenous administration of corticosteroids during pregnancy for the treatment of active IBD.
Multivariate logistic regression models were used to assess the impact of corticosteroid exposure on pregnancy outcomes. Models were adjusted for biologic, combination, or immunomodulator drug use.
The study cohort included 1490 mothers with a completed pregnancy, among whom 1431 had a live birth. Mean maternal age at birth was 32.0±4.6 years. Patients had Crohn disease (62%), ulcerative colitis (36%), and indeterminate colitis (2%).
Of the enrolled mothers, 432 (29.0%) reported corticosteroid use during pregnancy. Compared against mothers without corticosteroid exposure, mothers who used corticosteroids had a younger age at birth (32.2±4.4 vs 31.4±4.8 years; P =.002) and shorter median disease duration at enrollment (8.7 vs 7.1 years; P <.001). Mothers with ulcerative colitis were more likely to report corticosteroid exposure during pregnancy compared against mothers with Crohn disease (33.3% vs 26.1%; P =.005).
Overall, 68% of enrolled mothers experienced pregnancy complications of some kind, including spontaneous abortion (4%), preterm birth (10%), small for gestational age (4%), low birth weight (7%), intrauterine growth restriction (2%), caesarean section (44%), NICU admission (10%), and congenital malformation (9%).
In adjusted regression models, corticosteroid use was associated with significantly greater risk for preterm birth (odds ratio [OR], 1.79; 95% CI, 1.18-2.73), low birth weight (OR, 1.76; 95% CI, 1.07-2.88), and NICU admission (OR, 1.54; 95% CI, 1.03-2.30) compared with no corticosteroid use.
The timing of corticosteroid exposure also appeared to affect pregnancy outcomes. Compared with no exposure, corticosteroid use in the second and third trimesters was associated with an increase in serious infant infections requiring hospitalization at 9 months (2% vs 4%; P =.03) and 12 months (2% vs 5%; P =.001) of age. However, developmental milestones were achieved at similar time points across exposure groups. Overall, 6 infants were born with orofacial clefts: 5 with in utero corticosteroid exposure and 1 without.
Results from this multicenter prospective cohort study suggest that while most patients with IBD had uneventful pregnancies with healthy infants, the risk for complications increased substantially with prenatal corticosteroid use. Investigators noted, however, that it is difficult to separate the effects of disease activity from the effects of corticosteroid use. Associations may have been partially driven by worse disease activity in patients who used corticosteroids. However, even in models adjusted for disease activity, the association between corticosteroids and adverse outcomes persisted.
“These data demonstrate the importance of controlling disease activity before and during pregnancy with steroid-sparing agents,” investigators wrote. “Corticosteroid-free remission should be confirmed prior to conception and appropriate steroid-sparing therapy should be continued throughout pregnancy to avoid disease flares and need for corticosteroids whenever possible,” they concluded.
Disclosure: Two study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Odufalu FD, Long M, Lin K, Mahadevan U; PIANO Investigators from the Crohn’s and Colitis Foundation (CCF) Clinical Research Alliance recruited patients for their respective centers for participant enrollment. Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: results from the PIANO registry. Gut. Published online October 22, 2021. doi: 10.1136/gutjnl-2021-325317