Effect of Pregnancy on IBD Course

Many studies have been conducted on the effect of pregnancy on the course of intestinal inflammatory diseases [18-20]. From available meta-analytical data, we found that the probability of relapse of disease activity stages did not increase considerably during pregnancy or during puerperium. A study of over 500 pregnancies in patients suffering from UC in a quiescent stage revealed that the percentage of patient at risk for relapse of the active stage is 34%, similar to the rate of recrudescence of patients suffering from UC who are not pregnant [20]. Most relapses take place during the first trimester, partly because of the high frequency of therapy interruption during the pregnancy period.

In the abcence of therapy, UC in the active stage at the moment of conception shows a further worsening during pregnancy in 45% of patients; in 26%, it remains unchanged. In a small percentage of women, pregnancy causes improvement or remission during the disease activity stage, mostly during the first trimester. If conception occurs during the active stage, it is likely that the latter does not change during the entire course of pregnancy in about two thirds of patients. It may happen that the first acute onset of UC coincides with the beginning of pregnancy; in this case, its disease course tends to be particularly aggressive. Moreover, in some patients, the disease stays subclinical in the extra-pregnancy periods and becomes symptomatic only during pregnancy.

The course of CD during pregnancy is similar to UC. The patient with quiescent disease at the time of conception usually does not present a higher risk of a relapse during pregnancy whereas the patient conceiving during the activity stage presents a further worsening in one third of cases, and in one third they show no change at all [21]. There are no definitive data regarding desirable optimal duration of remission prior conception in order to assure a high probability of a favourable pregnancy course for both the expectant mother and the foetus; however, the longer the quiescence stage, the better the outcome.

In addition to disease activity state at the time of conception, according to two recent studies [22], a previous pregnancy might affect the overall course of IBD. In particular, in patients with UC, it seems that the more the parity increases, the lower the need for surgery. Moreover, patients with a history of multiple pregnancies would present, in comparison with non-parous patients, a need for a lower number of intestinal resections and a higher interval among the various surgeries besides a reduction of the rate of disease. These remarks should partly be explained by the effect of pregnancy on the immune system [22].

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