The impact of inflammatory bowel disease (IBD) and IBD medications during pregnancy on maternofetal health outcomes
We propose to build upon our expertise in IBD and extend our understanding of IBD upon pregnancy and neonatal outcomes. Our specific objectives and applicable corresponding hypotheses are outlined below:
1) Describe perinatal use of IBD medications and surgery by: a) quantifying prevalence of use of IBD medications; b) describing the prescribing patterns of IBD medication use in the year before, during (stratifying by gestational stage) and the year after pregnancy; c) describing the use of surgical interventions in the year before, during and the year after pregnancy.
2) Assess maternal outcomes associated with perinatal use of IBD medications and surgery by quantifying magnitude of risk of a) gestational diabetes, b) pre-eclampsia and eclampsia, c) pregnancy-related liver disease (HELLP, fatty liver, cholestasis), d) spontaneous abortions e) induction and f) first cesarean delivery to test the hypothesis that IBD medications and surgical interventions impact health outcomes of the mother
3) Assess neonatal outcomes associated with perinatal use of IBD medications by: a) quantifying magnitude of risk of i) congenital abnormalities (including cardiac abnormalities), ii) small for gestational age, iii) low birth weight, iv) preterm birth, v) stillbirth; b) quantifying the magnitude of risk of neonatal infections within first year of life; c) assess childhood development within first year of life by i) growth and ii) achievement of developmental milestones to test the hypothesis that IBD medications impact health outcomes of neonates/infants.
4) Assess maternal outcomes associated with IBD by: a) assessing fecundity rate by i) quantifying rates of pregnancy compared to general population and ii) quantifying rates of assisted reproductive technology for infertility including ovulation induction, intrauterine insemination, in vitro fertilization; b) quantifying the rates of perinatal complications: gestational diabetes, pre-eclampsia, eclampsia, pregnancy related liver disease, HELLP syndrome; c) quantifying the magnitude of risk of IBD flare; d) assess mode of delivery on maternal outcomes as related to i) IBD activity in first year post-partum and ii) perineal complications in first year post-partum to test the hypothesis that IBD can impact health outcomes of mother.
5) Assess neonatal/infant/childhood outcomes associated with maternal IBD by: a) quantifying the incidence of IBD up to first 10 years of life; b) assess if mode of delivery is associated with development of IBD in first 10 years of life to test the hypothesis that maternal IBD can impact health outcomes of infants.
6) Assess health resource utilization in IBD patients in the perinatal period by: a) assessing emergency visits, hospital admissions, length of hospital stay, and imaging (ultrasound, MRI) and their related cost compare to general perinatal population; b) assess the procedural costs in amniocentesis, endoscopy compared to general perinatal population; and c) assess the type of use of delivery personnel (mid-wives, general practitioners, obstetricians) to test the hypothesis that IBD patients utilize more health resources during pregnancy compared to other pregnant women.