Pregnant women with acute severe ulcerative colitis (ASUC) were found to respond to standard therapies, with a majority able to avoid colectomy in the short-term and long-term, according to study data published in Clinical Gastroenterology and Hepatology.
The retrospective observational study included 20 pregnant women hospitalized for ASUC at 2 large tertiary medical centers between January 2003 and December 2018. The study authors also conducted a systematic literature review for case series or observational cohort studies reporting on the outcome of ASUC in hospitalized pregnant patients. The primary end point was colectomy-free survival; secondary end points included gestational period, birth weight, stillbirth rate, and congenital malformations.
The median patient age at admission was 30.3 years (interquartile range [IQR], 23.4-32.0), and the median gestational age was 21 weeks (IQR, 14-28). The median follow-up was 48 months (IQR, 20.7-80.0).
All patients received intravenous steroids, and half received tumor necrosis factor (TNF) antagonist therapy as salvage therapy. A total of 19 inpatients responded to either steroids (10 patients) or TNF antagonist therapy after steroid treatment failed (9 patients). Women who received TNF antagonist therapy (as inpatients) continued to maintenance therapy with TNF antagonists. Regarding participants who responded to corticosteroid therapy, 7 transitioned to mesalamine preparations, and 1 patient each received vedolizumab, adalimumab, and azathioprine.
Six patients (30%) underwent colectomy. Colectomy-free survival rates from admission were 90% at 6 months, 84% at 1 year, and 64% at 4 years. One patient had a colectomy at her index admission and later had an uncomplicated birth. A total of 18 women (90%) had a live birth; the median gestational age at birth was 37 weeks (IQR, 34.5-38.0).
Adverse pregnancy outcomes included 2 spontaneous abortions, 6 premature births (median gestational age, 33 weeks), and 4 low birth weight infants. No stillbirths occurred, and no major congenital abnormalities were observed.
Regarding the literature search, the researchers identified 2 case series of 12 and 7 patients. The pooled outcome of the 3 studies showed that 3 of 39 patients (7.7%) underwent colectomy during their index admission. The combined colectomy-free survival rates from admission were 87.2% at 6 months, 84.6% at 1 year, and 84.6% at 2 years.
Study limitations included the retrospective design and small number of patients. Further, “some overestimation of disease severity” was expected due to the use of the Truelove and Witts criteria in pregnancy, which involve hemoglobin, because hemoglobin is “frequently reduced in normal pregnancy,” according to the investigators.
“These patients respond to standard therapies, and the majority were able to avoid colectomy in the short-term as well as the long-term,” the study authors concluded. “Nearly all patients had live births, and serious fetal complications were rare.”
Ollech JE, Avni-Biron I, Glick L, et al. Effective treatment of acute severe ulcerative colitis in pregnancy is associated with good maternal and fetal outcomes. Clin Gastroenterol Hepatol. Published online October 22, 2020. doi:10.1016/j.cgh.2020.10.035