Millie Long, MD, on PIANO: Lessons in Pregnancy in IBD

“So, pregnancy becomes very important for women with inflammatory bowel disease [IBD], because diagnosis of IBD is most often during childbearing years,” Dr Long said during the opening of her presentation on “PIANO: Lessons in Pregnancy in IBD” during the Advances in Inflammatory Bowel Disease regional meeting on September 25.

Millie Long, MD, is an associate professor of medicine and director of the Gastroenterology and Hepatology Fellowship Program at the University of North Carolina at Chapel Hill.

“It’s really important to recognize knowledge is power for many of these young people. Lack of knowledge on IBD and pregnancy is associated with childlessness—people thinking their disease makes it so they can’t become pregnant—and we want them to understand the true knowledge surrounding this: If a woman enter pregnancy in remission, she can have a very healthy and successful pregnancy,” Dr Long explained.

In support, Dr Long showed the results from the Crohn’s and Colitis Pregnancy Knowledge (CCPKnow) questionnaire, revealing the importance of gastroenterologists discussing family planning with patients with gastrointestinal (GI) concerns. “We as gastroenterologists have a responsibility really to discuss family planning and pregnancy data with our patients because this really helps to improve this knowledge and reduces rates of voluntary childlessness,” she stated.

Dr Long moved on the importance of clearing up common misbeliefs, which often center around medications and pregnancy. “Many women believe ‘medications are harmful to my baby’ and ‘I can put up with the symptoms as long as my baby is safe’; however, it’s actually the exact opposite,” Dr Long explained. “It’s actually the active disease that impacts the complications surrounding that pregnancy, so really we need to treat with medications to avoid those outcomes.”

Dr Long further explained misbeliefs surrounding pregnancy and IBD, which are not limited to patients—providers also possess misbeliefs surrounding IBD and pregnancy. Dr Long displayed a chart detailing the percentage of health care providers (HCPs) who recommended discontinuing TNF inhibitor treatment before pregnancy. Many HCPs recommended discontinuing treatment, which is not what Dr Long would recommend, and encourages gastroenterologists to communicate their knowledge of treating IBD during pregnancy with other HCPs to improve outcomes.

She went on to explain the results of the PIANO Study manuscript, which she described as a “labor of love for Uma Mahadevan, who is the principal author of this, [because] this study has been going on for over a decade. In this study, there were 1490 women included, [of which] 379 were not on an advanced therapy, 242 were on a pill-based medicine, 642 were on a biologic, and 227 were on combination therapy. These pregnancies resulted in 1431 live births, and importantly, there was no increase in congenital malformations, spontaneous abortions, preterm births, low birth weight, or infections in the first year. However, one thing we did learn in this cohort was there was an increase in infections among preterm birth deliver.”

Disease activity itself was linked to risk of spontaneous abortion, but there was no negative impact of drug exposure.

Dr Long discussed the importance of preconception counseling with patients and how it may improve disease activity outcomes during pregnancy. She showed a chart focusing on the results of PIANO. “Interestingly, this was a project Marla Dubinsky did that looked at preconception care, and among those that had these discussions as planning prior to pregnancy, you saw important things like more folate intake, more smoking cessation, and fewer discontinuation of medication due to concerns of impact on pregnancy.”

She also focused on outcomes by drug class, which further explained the importance of controlling the disease to avoid adverse outcomes.

“When we look at serious infection at birth, these numbers are fortunately very low,” Dr Long reported. In detecting biologics in the placenta and breastmilk, Dr Long reported “it did seem that these drugs did cross the placenta … but again, this did not have adverse outcomes,” and “breastfeeding while on biologics does not adverse effect on infant growth, developmental milestones, or infection rate. Again, these data are reassuring, and women should be encouraged to breastfeed if that is something they are interested in.”

Wrapping up her presentation, Dr Long touched on her key takeaways, including IBD diagnosis during childbearing years is common, as are misconceptions that HCPs should work to correct by sharing knowledge during preconception counseling.

“Improve knowledge to reduce complications, and remember PIANO: Biologics are safe, and active disease has complications. We really need to continue our therapies, limit steroids, if possible, encourage breastfeeding and appropriate interventions like vaccination, and a healthy mom is equal to a healthy baby,” Dr Long concluded.

—Angelique Platas

Reference

Long M, PIANO: lessons in pregnancy in IBD. Presented at: Advances in Inflammatory Bowel Diseases regional meeting; September 25, 2021; Virtual.