Colon to Rectum
Gut. 2022;71(9):1766–72
Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: Results from the PIANO registry
Objective: Active inflammatory bowel disease (IBD) during pregnancy may require the use of corticosteroids. The aim of this study was to investigate the impact of in utero corticosteroid exposure on adverse pregnancy outcomes, congenital malformations, infections and neurocognitive development among offspring of mothers with IBD.
Design: Using the prospective Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) registry, data were collected at each trimester, delivery; and in the 12 months post partum. Bivariate statistics and multivariate logistic regression models compared pregnancy outcomes by corticosteroid exposure.
Results: A total of 1490 mothers with IBD were enrolled, with 1431 live births recorded. Corticosteroid use was associated with increased risk of preterm birth, small for gestational age, low birth weight (LBW), intrauterine growth restriction and neonatal intensive care unit (NICU) admission. On adjusted multivariate models, corticosteroid use was associated with preterm birth (odds ratio [OR] = 1.79, 95% confidence interval [CI]: 1.18–2.73), LBW (OR = 1.76, 95% CI: 1.07–2.88) and NICU admission (OR = 1.54, 95% CI: 1.03–2.30). Late corticosteroid use (second and/or third trimester) was associated with serious infections at 9 and 12 months (4% vs. 2% and 5% vs. 2%, respectively, p = 0.03 and p = 0.001). There were 5 newborns with in utero corticosteroid exposure born with orofacial clefts versus 1 without corticosteroid exposure. Developmental milestones were similar across corticosteroid exposure groups.
Conclusion: In this prospective pregnancy registry, offspring of women exposed to corticosteroids during pregnancy were more likely to have adverse pregnancy outcomes. This emphasizes the importance of controlling disease activity before and during pregnancy with steroid-sparing therapy.