Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
J Crohns Colitis. 2021 May 4;15(5):719-732. doi: 10.1093/ecco-jcc/jjaa225.
Robust evidence regarding the impact of disease activity on pregnancy outcomes in women with inflammatory bowel disease [IBD] is crucial for both clinicians and patients in preparing a birth plan. We sought to perform a systematic review and meta-analysis to assess the pooled influences of disease activity on pregnancy outcomes in women with IBD.
We searched MEDLINE, EMBASE and the COCHRANE library to identify articles comparing pregnancy outcomes between active and inactive IBD at the time of conception or during pregnancy. A meta-analysis was performed using a random-effects model to pool estimates and report odds ratios [ORs].
A total of 28 studies were identified as eligible for the meta-analysis. In women with active IBD, the pooled ORs for low birth weight [LBW], preterm birth, small for gestational age [SGA], spontaneous abortion and stillbirths were respectively 3.81 (95% confidence interval [CI] 1.81-8.02), 2.42 [95% CI 1.74-3.35], 1.48 [95% CI 1.19-1.85], 1.87 [95% CI 1.17-3.0] and 2.27 [95% CI 1.03-5.04] compared to women with inactive IBD. In the subgroup analysis based on disease type, women with active ulcerative colitis had an increased risk of LBW, preterm birth and spontaneous abortion. Women with active Crohn's disease had a higher risk of preterm birth, SGA and spontaneous abortion.
Active IBD during the periconception period and pregnancy is associated with an increased risk of adverse pregnancy outcomes. Our data suggest that pregnancy should be planned when the disease is quiescent, and continuous disease control is important even during pregnancy.
有强有力的证据表明，炎症性肠病（IBD）患者的疾病活动度对妊娠结局有影响，这对于临床医生和患者制定生育计划都至关重要。我们旨在进行系统评价和荟萃分析，评估 IBD 患者疾病活动度对妊娠结局的综合影响。
我们检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，以确定在受孕时或怀孕期间比较 IBD 活动期和非活动期妊娠结局的文章。使用随机效应模型对估计值进行荟萃分析，并报告比值比（ORs）。
共有 28 项研究被确定符合荟萃分析的条件。在患有活动期 IBD 的女性中，低出生体重（LBW）、早产、小于胎龄儿（SGA）、自然流产和死胎的汇总 OR 分别为 3.81（95%置信区间 [CI] 1.81-8.02）、2.42 [95% CI 1.74-3.35]、1.48 [95% CI 1.19-1.85]、1.87 [95% CI 1.17-3.0] 和 2.27 [95% CI 1.03-5.04]，与非活动期 IBD 的女性相比。基于疾病类型的亚组分析显示，活动期溃疡性结肠炎女性 LBW、早产和自然流产的风险增加。活动期克罗恩病女性早产、SGA 和自然流产的风险较高。
受孕前和怀孕期间的活动期 IBD 与不良妊娠结局的风险增加相关。我们的数据表明，应在疾病缓解时计划妊娠，即使在怀孕期间，也应持续控制疾病。
