Annual Scientific Meeting
Introduction: Inflammatory bowel disease (IBD) commonly affects women during their childbearing years, and mode of delivery is a frequent topic of concern. Rates of Cesarean section (C-section) are increased in women with IBD. Biologics are commonly used during pregnancy and data on their effect on C-section outcomes are limited. We investigated whether exposure to biologic agents impacts wound healing after C-section in women with IBD.
Methods: Women with IBD seeking consultation at the Marie and Barry Lipman IBD Preconception and Pregnancy Planning (I-PrePP) Clinic between years 2015-2019 were eligible. Delivery data collected as part of the I-PrePP prospective registry were analyzed. Primary outcome was rate of surgical site infection prior to discharge and/or at follow-up visits 2 and 6 weeks after delivery. Timing of biologics were investigated as well as impact of steroids on wound healing. Descriptive statistics summarized patient level data using frequency for categorical variables and median [IQR] for continuous.
Results: Of the 84 women who presented or became pregnant after their I-PrePP consultation, delivery data was available from 64 (38 (59%) Crohn’s disease, 24 (38%) ulcerative colitis, 2 IBD-U (3%)) pregnancies (median [IQR] age 33 [29-35] years). Indications for the 37 C-sections (58%) included: history of perianal disease (n=12, 32%), severely active inflammation (n=1, 3%), ileal pouch anal anastomosis or end ileostomy (n=2, 5%), previous C-section (n=7, 19%), other obstetrical indications (large for gestational age, arrest of labor, malpresentation) (n=14, 38%), or other (n=1, 3%). Twenty six of 37 (70%) women with C-sections were exposed to biologics during pregnancy: infliximab (n=13, 35%), adalimumab (n=5, 14%), ustekinumab (n=3, 8%), vedolizumab (n=4, 11%), and certolizumab (n=1, 3%). Time from last dose to delivery was 6 [4-7] weeks, and 21 of 26 (81%) received therapy at the time of (n= 10) and/or within 2 weeks (n=11) of delivery. Four (11%) were exposed to systemic steroid therapy, including 2 patients at the time of and/or within 2 weeks of delivery. There was no incidence of surgical site infection in the biologic exposed patients, 1 case of MRSA bacteremia with an intra-abdominal abscess in a patient on systemic steroids, and 1 superficial infection in a non-medicated patient.
Discussion: Our data suggests that biologics exposure in the peripartum period does not adversely affect wound healing after cesarean section in women with IBD.