LAUSR

Since the peak age of reproduction coincides with the peak incidence of inflammatory bowel disease (IBD), many female patients worry about the effect of pregnancy on disease activity, the effect of IBD on pregnancy and birth outcomes, and the effect of IBD medications on the developing fetus. As the study of pregnancy in IBD is complex, current research must attempt to separate the effects of confounders such as disease activity at conception and during pregnancy, medication use, comorbidities, gestational weight gain, and history of IBD surgery. Most pregnancy studies are performed in Europe or the USA with little data from Asia, an area in which IBD incidence is increasing rapidly. Since therapeutic monoclonal antibodies (biologics) are increasingly used to treat IBD in the USA and Europe, much of the recent research focuses on their safety during pregnancy. In India, where treatment with biologics is less common, Padhan et al. [1], writing in this issue of Digestive Diseases and Sciences, were able to measure the effect of IBD on pregnancy and vice versa in cohort of women, most of whom were not treated with biologic therapy. What makes this study unique is that for the first time the authors compare non-pregnant patients to patients whose pregnancy antedated disease onset, coincided with disease onset, or occurred after the onset of disease. The authors also examine the pregnancy outcomes of mode of delivery, abortion, stillbirth, preterm, full term, and postdated. This study was performed at the All India Institute of Medical Sciences (AIIMS), a premier medical research university and hospital located in New Delhi, India. The cohort of 406 women included both non-pregnant IBD patients and IBD patients who had had one or more pregnancies. Almost half of the patients had a pregnancy before IBD onset [49.3% ulcerative colitis (UC) and 45.7% Crohn’s disease (CD)] A small percentage of patients had a pregnancy that coincided with onset of disease (5.1% UC and 7.1% CD). The remaining patients had pregnancies before and after disease onset (8.6% UC and 17.1% CD), only after disease onset (12.5% UC and 7.1% CD), or had never been pregnant (23.8% UC and 23% CD). Though it is helpful to group patients in this way to compare results, the groups were small. Since only *25% of patients had both IBD and a pregnancy at the same time (110 patients; 88 UC and 22 CD) (Padhan et al., Table 3), important outcomes may have been missed. The group of patients heretofore never reported in the IBD literature, and perhaps the most interesting group, is those whose pregnancy coincided with the onset of IBD, consisting in this study of only 22 patients (17 UC and 5 CD). While 52% of patients received treatment with azathioprine/6-mercaptopurine, only 3% received biologics. Although initiation of corticosteroid treatment was incorporated into the authors’ definition of a disease exacerbation, no data on overall steroid use were available in these patients. Given the lack of use of biologic therapy, it is possible that this group of patients had more active disease than is typically seen in the West. Since the authors’ definition of disease activity does not separate out exacerbations during the pregnancy itself but rather examines the overall disease course, data on disease activity or medication use exclusively during each pregnancy are not available. The authors’ stated purpose, to examine the overall disease course over years among the different groups of patients, was, however, achieved. While no & Sonia Friedman [email protected]