- Email: [email protected]
Fetal outcome of women with inflammatory bowel disease
April 2000
AGAA315
1728
1730
FETAL OUTCOME OF WOMEN WITH INFLAMMATORY BOWEL DISEASE. Sharon L. Masel, Sabrina Fraser-Thomson, Stephen B. Hanauer, Univ of Chicago, Chicago, IL. Background: Studies have been reassuring regarding IBD drug safety although data is conflicting regarding the overall impact of IBD on fetal outcome. Aims: To assess the impact of CD or UC, disease activity & therapy on fetal outcome. Methods: Women aged 18 to 50 from the Univ. <::hica~o IBD clinic & nominated controls were asked to complete questionnaires regarding pregnancy. Results: 33 women with IBD (22 CD, 9 UC) & 28 controls responded. 38 children were born to 24 women with CD, 17 to 9 UC & 52 to 28 controls. Gestation was reduced in IBD (p<0.05), birth weight reduced in CD (p<0.02) & length no different among groups by t-test. PTB, LBW, congenital malformations (cong malt) & prolongedjaundice were increased in CD but this was not significant. 7 w~re taking prednisone, 13 ASA & 3 immunomodu1ators during the I" tnmester (Tl). Of the 6 pregnancies resulting in cong malf, 5 women were taking no medication, 1 6MP, & all 6 had quiescent disease in T1. Alcohol ~se was similar in IBD (9%) & controls (11%), p=ns. Smoking was greater in controls (43%) than IBD (6%), p
LEWIS PHENOTYPE INFLUENCES ULCERATIVE COLITIS (UC) EXTENT. Spyros Michopoulos, Panayiotis Tsibouris, Despina Katopi, Maria Sotiropoulou, Valia Giotopoulou, Angeliki Balta, Georgios Galanopoulos, Nick Kralios, Alexandra Hosp Gastroenterology Dept, Athens, Greece; Alexandra Hosp Hematology Div, Athens, Greece; Alexandra Hosp Pathology Div, Athens, Greece; Alexandra Hosp, Athens, Greece. Red cell Lewisblood group phenotype (Le) is relatedto variousautoimmune di~eases. In t1;Je colon of UC patients with sclerosing cholangitis an inappropnate expression of LeWIS antigens (LE) has beendescribed. Aimof the study: Investigate a possible association between: I) inflammatory bowel diseases (ffiD) and Le or LE 2) Le or LE expression and diseaseextent. Patients and methods: 74 patients with ffiD (55 UC, 19 Crohn s disease (CD) mean age 45:!::18.2 years, 39 men, 24 smokersand 9 ex-smokers) and 83 blood donors (43.8:!:: 11.2years,54 men, 38 smokersand 7 ex-smokers). Le was determined by standard hemagglutination using murine monoclonal Bioclone®reagents (OrthoDiagnostic, USA). ABObloodgroupand p-ANCAwerealsotested.In IBD patients, full colonoscopy withmultiple biopsiesto excludedysplasia and neoplasia was performed. LE was determined by immunohistochemistry using the immunoalkaline posphatase (DAKO, Danemark). Stat:X2 test.Results: Le phenotype was identical despite the exacerbation or remission of the disease. The concordance between Le and LE was 80.4% (69.9-91.1) in UC patients and 63.2%(39.3-87) in CD patients. Le and LE of both controlsand patients, are resumed in the following table: p in the table represents differences between patients and controls. Le amongUC subgroups: p
Fetal Outcome inIBD Offspring Gestation Weight Length PTB LBW Cong malt Jaundice
CD (n=38)
UC (n=17)
Control (n=52)
38.3310250 11 5 5 6
3833254 50 4 1 1 1
39.2 3396 51 7 2 2 5
-p=sig,mean fetal gestation (wk), birth weight (gm), birth length (em), PTB< than 37 weeks gestation, LBW<2500g, cong malformation tnsomy21, short limbs,skeletal deformx2,elub feet,min fnsmall kidney,VSD,cong heart disease.
Extent
Le(a+b·)
Le(a·b+)
Le(a·b·)
p
LE(a+b-)
LE(a-b+)
LE(a·b-)
17 14 2 1 4 9
27 7 13 7 13 60
11 2 5 4 2 14
<0.01 <0.001 >0.1 >0.1 >0.1
23 17' 5 1 7
21 4 10 7 9
11 2 5 4 3
UCTotal Proctitis LeftUC Pancoliti CD Controls
1731 1729 COURSE OF INFLAMMATORY BOWEL DISEASE DURING PREGNANCY. Sharon L. Masel, Jennifer F. Tsang, Stephen B. Hanauer, Univ of Chicago, Chicago, IL. Background: Data is conflicting regarding the activity of IBD during pregnancy and postpartum. Aims: To determine the course of IBD activity from conception to the postpartum period and requirement for medical therapy, hospitalization and surgery during pregnancy. Methods: Women aged 18 to 50 were recruited from the University of Chicago IBD clinic to complete a questionnaire regarding IBD activity and therapy during previous pregnancies. Results: 33 women reported 55 children (38 to 24 women with CD, 17 to 9 with UC including 1 set of twins). 21 (55%) women with CD and II (69%) with UC were in remission at conception. 11/21 (52%) with CD and 9/11 (82%) with UC remained in remission throughout the pregnancy and postpartum period. 12 women in remission at conception reported flare-ups (3 in the first, 4 in second, 3 in third trimester, and 2 postpartum). Of the 23 women with active disease at conception (17 CD and 6 UC), 12/17 (71%) with CD and 5/6 (83%) with UC remained active throughout the pregnancy and postpartum period. The remaining 5/17 (29%) with CD and 1/6 (17%)with UC who had active disease at conception went into remission during the pregnancy. 6/38 (16%) CD pregnanciesand 1/16 (6%) with UC required hospitalization for IBD. Two women with CD (5%) and none with UC required IBD surgery during pregnancy. Three women with CD (23%) and none with UC in remission during the third trimester had a postpartum flare. Three (25%) women with CD and I (20%) with UC reporting active disease at delivery went into remission postpartum. Conclusions: Women with CD and UC who conceive while IBD is active are likely to continue to have ongoing symptoms during pregnancy and postpartum. In contrast, women with quiescent UC at conception remain were more likely to remain free of symptoms throughout pregnancy. Approximately 50% of women with quiescent CD at conception flared during pregnancy without an apparent disposition to flare within any particular trimester. In CD, postpartum flare-up or remission was not predictable. No UC patient reported a postpartum flare and 20% with active disease in the third trimester went into a postpartum remission. Hospitalization and surgery for IBD are uncommon during pregnancy even in a tertiary referral center. Larger, prospective studies are still needed to clarify the effect of pregnancy on IBD activity. Dr S. Masel is funded in 1999 by a scholarship from the University of Western Australia. Additional support from the Reva & David Logan GI Clinical Research Center.
ARE LEFT·HANDED PEOPLE AT INCREASED RISK OF IN· FLAMMATORY BOWEL DISEASE? Danielle L. Morris, Scott M. Montgomery, Maria L. Galloway, Roy E. Pounder, Andrew J. Wakefield, Royal Free and Univ Coli Med Sch, London, United Kingdom. B.ackground: Left-handedness has been associated with inflammatory bowel disease (ffiD) and autoimmune diseases. Aims: To determine whether lefthandedness is associated with ffiD in two prospective national birth cohort studies. Methods: Subjects with Crohn's disease (CD) and ulcerative colitis (UC) were i~~ntified from two national longitudinal birth cohorts at age 26-years (British Cohort Study, BCS70, born in 1970) and age 33-years (National Child Development Study, NCDS, born in 1958). Laterality based on hand preference for writing and foot preference for kicking a ball, was dete~med at 10 (BCS70) and 7 (NCDS)years. Multiplelogistic regression and FIsher' s exact test were used to assess the relationship betweenhandedness and CD, UC, and ffiD in each cohortand cohortscombined and adjusted for sex. Results: Both cohorts showed increased relativeodds for CD (combinedadjusted OR 2.13,95% CI 0.97-4.65), UC (combined adjusted OR 2.13, 95%CI 0.92-4.91)in left handers. For the BCS70,the association withUC was statistically significant (Adjusted OR 2.79, 95% CI 1-7.77). Combining cohorts therewas a significant association betweenleft handedness and ffiD (see table). There was no statistically significant association between foot preference and CD. For UC, 27.8% showed left foot preference, compared with 12.7% of those withoutthe disease(Oddsratio2.64,95% confidence intervals 0.94 to 7.42, Fisher's 2-tailed p=0.069). Conclusions: In this study lefthandedness is significantly associated with ffiD. The consistency of these findings in both cohortsand withboth UC and CD strengthens the validityand suggests a link, betweenffiD and lateralisation which may be geneticand/or environmental in origin. Relative Odds forinflammatory bowel disease inlefthanded SUbjects (Adjusted forsex) Birth cohort
BCS70 Left·handed NCDS Left·handed NCDS & BCS70 Left·handed
NwithIBD (%)
Nwithout IBD (%)
Adjusted Relative Odds (95% el)
9/40 (22.5)
916/8094(11.3)
2.27 (1.08-4.79)"
6/31 (194)
996/9031 (11)
1.94 (0.79-4.75)
15/71 (21)
1912117125(11)
2.13 (1.20..3.78)1
ocFisher's 2-sided p=O.040 tPearson's p;O.OO8
AGAA315
1728
1730
FETAL OUTCOME OF WOMEN WITH INFLAMMATORY BOWEL DISEASE. Sharon L. Masel, Sabrina Fraser-Thomson, Stephen B. Hanauer, Univ of Chicago, Chicago, IL. Background: Studies have been reassuring regarding IBD drug safety although data is conflicting regarding the overall impact of IBD on fetal outcome. Aims: To assess the impact of CD or UC, disease activity & therapy on fetal outcome. Methods: Women aged 18 to 50 from the Univ. <::hica~o IBD clinic & nominated controls were asked to complete questionnaires regarding pregnancy. Results: 33 women with IBD (22 CD, 9 UC) & 28 controls responded. 38 children were born to 24 women with CD, 17 to 9 UC & 52 to 28 controls. Gestation was reduced in IBD (p<0.05), birth weight reduced in CD (p<0.02) & length no different among groups by t-test. PTB, LBW, congenital malformations (cong malt) & prolongedjaundice were increased in CD but this was not significant. 7 w~re taking prednisone, 13 ASA & 3 immunomodu1ators during the I" tnmester (Tl). Of the 6 pregnancies resulting in cong malf, 5 women were taking no medication, 1 6MP, & all 6 had quiescent disease in T1. Alcohol ~se was similar in IBD (9%) & controls (11%), p=ns. Smoking was greater in controls (43%) than IBD (6%), p
LEWIS PHENOTYPE INFLUENCES ULCERATIVE COLITIS (UC) EXTENT. Spyros Michopoulos, Panayiotis Tsibouris, Despina Katopi, Maria Sotiropoulou, Valia Giotopoulou, Angeliki Balta, Georgios Galanopoulos, Nick Kralios, Alexandra Hosp Gastroenterology Dept, Athens, Greece; Alexandra Hosp Hematology Div, Athens, Greece; Alexandra Hosp Pathology Div, Athens, Greece; Alexandra Hosp, Athens, Greece. Red cell Lewisblood group phenotype (Le) is relatedto variousautoimmune di~eases. In t1;Je colon of UC patients with sclerosing cholangitis an inappropnate expression of LeWIS antigens (LE) has beendescribed. Aimof the study: Investigate a possible association between: I) inflammatory bowel diseases (ffiD) and Le or LE 2) Le or LE expression and diseaseextent. Patients and methods: 74 patients with ffiD (55 UC, 19 Crohn s disease (CD) mean age 45:!::18.2 years, 39 men, 24 smokersand 9 ex-smokers) and 83 blood donors (43.8:!:: 11.2years,54 men, 38 smokersand 7 ex-smokers). Le was determined by standard hemagglutination using murine monoclonal Bioclone®reagents (OrthoDiagnostic, USA). ABObloodgroupand p-ANCAwerealsotested.In IBD patients, full colonoscopy withmultiple biopsiesto excludedysplasia and neoplasia was performed. LE was determined by immunohistochemistry using the immunoalkaline posphatase (DAKO, Danemark). Stat:X2 test.Results: Le phenotype was identical despite the exacerbation or remission of the disease. The concordance between Le and LE was 80.4% (69.9-91.1) in UC patients and 63.2%(39.3-87) in CD patients. Le and LE of both controlsand patients, are resumed in the following table: p in the table represents differences between patients and controls. Le amongUC subgroups: p
Fetal Outcome inIBD Offspring Gestation Weight Length PTB LBW Cong malt Jaundice
CD (n=38)
UC (n=17)
Control (n=52)
38.3310250 11 5 5 6
3833254 50 4 1 1 1
39.2 3396 51 7 2 2 5
-p=sig,mean fetal gestation (wk), birth weight (gm), birth length (em), PTB< than 37 weeks gestation, LBW<2500g, cong malformation tnsomy21, short limbs,skeletal deformx2,elub feet,min fnsmall kidney,VSD,cong heart disease.
Extent
Le(a+b·)
Le(a·b+)
Le(a·b·)
p
LE(a+b-)
LE(a-b+)
LE(a·b-)
17 14 2 1 4 9
27 7 13 7 13 60
11 2 5 4 2 14
<0.01 <0.001 >0.1 >0.1 >0.1
23 17' 5 1 7
21 4 10 7 9
11 2 5 4 3
UCTotal Proctitis LeftUC Pancoliti CD Controls
1731 1729 COURSE OF INFLAMMATORY BOWEL DISEASE DURING PREGNANCY. Sharon L. Masel, Jennifer F. Tsang, Stephen B. Hanauer, Univ of Chicago, Chicago, IL. Background: Data is conflicting regarding the activity of IBD during pregnancy and postpartum. Aims: To determine the course of IBD activity from conception to the postpartum period and requirement for medical therapy, hospitalization and surgery during pregnancy. Methods: Women aged 18 to 50 were recruited from the University of Chicago IBD clinic to complete a questionnaire regarding IBD activity and therapy during previous pregnancies. Results: 33 women reported 55 children (38 to 24 women with CD, 17 to 9 with UC including 1 set of twins). 21 (55%) women with CD and II (69%) with UC were in remission at conception. 11/21 (52%) with CD and 9/11 (82%) with UC remained in remission throughout the pregnancy and postpartum period. 12 women in remission at conception reported flare-ups (3 in the first, 4 in second, 3 in third trimester, and 2 postpartum). Of the 23 women with active disease at conception (17 CD and 6 UC), 12/17 (71%) with CD and 5/6 (83%) with UC remained active throughout the pregnancy and postpartum period. The remaining 5/17 (29%) with CD and 1/6 (17%)with UC who had active disease at conception went into remission during the pregnancy. 6/38 (16%) CD pregnanciesand 1/16 (6%) with UC required hospitalization for IBD. Two women with CD (5%) and none with UC required IBD surgery during pregnancy. Three women with CD (23%) and none with UC in remission during the third trimester had a postpartum flare. Three (25%) women with CD and I (20%) with UC reporting active disease at delivery went into remission postpartum. Conclusions: Women with CD and UC who conceive while IBD is active are likely to continue to have ongoing symptoms during pregnancy and postpartum. In contrast, women with quiescent UC at conception remain were more likely to remain free of symptoms throughout pregnancy. Approximately 50% of women with quiescent CD at conception flared during pregnancy without an apparent disposition to flare within any particular trimester. In CD, postpartum flare-up or remission was not predictable. No UC patient reported a postpartum flare and 20% with active disease in the third trimester went into a postpartum remission. Hospitalization and surgery for IBD are uncommon during pregnancy even in a tertiary referral center. Larger, prospective studies are still needed to clarify the effect of pregnancy on IBD activity. Dr S. Masel is funded in 1999 by a scholarship from the University of Western Australia. Additional support from the Reva & David Logan GI Clinical Research Center.
ARE LEFT·HANDED PEOPLE AT INCREASED RISK OF IN· FLAMMATORY BOWEL DISEASE? Danielle L. Morris, Scott M. Montgomery, Maria L. Galloway, Roy E. Pounder, Andrew J. Wakefield, Royal Free and Univ Coli Med Sch, London, United Kingdom. B.ackground: Left-handedness has been associated with inflammatory bowel disease (ffiD) and autoimmune diseases. Aims: To determine whether lefthandedness is associated with ffiD in two prospective national birth cohort studies. Methods: Subjects with Crohn's disease (CD) and ulcerative colitis (UC) were i~~ntified from two national longitudinal birth cohorts at age 26-years (British Cohort Study, BCS70, born in 1970) and age 33-years (National Child Development Study, NCDS, born in 1958). Laterality based on hand preference for writing and foot preference for kicking a ball, was dete~med at 10 (BCS70) and 7 (NCDS)years. Multiplelogistic regression and FIsher' s exact test were used to assess the relationship betweenhandedness and CD, UC, and ffiD in each cohortand cohortscombined and adjusted for sex. Results: Both cohorts showed increased relativeodds for CD (combinedadjusted OR 2.13,95% CI 0.97-4.65), UC (combined adjusted OR 2.13, 95%CI 0.92-4.91)in left handers. For the BCS70,the association withUC was statistically significant (Adjusted OR 2.79, 95% CI 1-7.77). Combining cohorts therewas a significant association betweenleft handedness and ffiD (see table). There was no statistically significant association between foot preference and CD. For UC, 27.8% showed left foot preference, compared with 12.7% of those withoutthe disease(Oddsratio2.64,95% confidence intervals 0.94 to 7.42, Fisher's 2-tailed p=0.069). Conclusions: In this study lefthandedness is significantly associated with ffiD. The consistency of these findings in both cohortsand withboth UC and CD strengthens the validityand suggests a link, betweenffiD and lateralisation which may be geneticand/or environmental in origin. Relative Odds forinflammatory bowel disease inlefthanded SUbjects (Adjusted forsex) Birth cohort
BCS70 Left·handed NCDS Left·handed NCDS & BCS70 Left·handed
NwithIBD (%)
Nwithout IBD (%)
Adjusted Relative Odds (95% el)
9/40 (22.5)
916/8094(11.3)
2.27 (1.08-4.79)"
6/31 (194)
996/9031 (11)
1.94 (0.79-4.75)
15/71 (21)
1912117125(11)
2.13 (1.20..3.78)1
ocFisher's 2-sided p=O.040 tPearson's p;O.OO8