P040  Indications for Cesarean Section in Pregnant Women with Inflammatory Bowel Disease: Results from the PIANO Registry

P040  Indications for Cesarean Section in Pregnant Women with Inflammatory Bowel Disease: Results from the PIANO Registry
 

Lewin Sara1, Long Millie2, Mahadevan Uma1
1 University of California, San Francisco, San Francisco, United States, 2 University of North Carolina at Chapel-Hill, Chapel Hill, United States

BACKGROUND: Women with inflammatory bowel disease (IBD) experience high rates of cesarean section (c-section) delivery. Elective c-section is recommended for active perianal disease and should be considered in patients with ileal pouch anal anastomosis to prevent perineal complications of vaginal delivery. The majority of pregnant IBD patients do not require elective c-sections for these indications, yet c-section rates remain high. We aimed to determine factors associated with c-section among women with IBD, including whether pharmacologic therapy was associated with mode of delivery.
 

METHODS: In a multi-center prospective cohort of pregnant women with IBD, we collected demographic information, IBD disease and treatment history (unexposed, biologic therapy, immunomodulator therapy, or combination therapy), and pregnancy and labor history. Data were collected using questionnaires each trimester of pregnancy and post-partum. We evaluated c-section rates by treatment class, and additionally evaluated factors associated with c-section in each treatment class. We utilized bivariate analyses to compare across groups, and performed logistic regression models controlling for steroid use, active disease, and maternal age to determine odds of c-section by treatment class.

RESULTS: There were 1,490 women in the cohort, with 1431 live births.  A total of 618 (41.5%) underwent c-section (Table 1). The most common indications for c-section were active IBD (33%), perianal IBD (19%), elective (14%), breech or abnormal position (12%), prolonged labor (10%), fetal distress (9%), pre-term delivery (9%), augmented labor failure (5%), and pre-eclampsia (5%). Among those who had a c-section, those with an elective indication were more likely to be on biologic therapy or combination biologic and immunomodulator therapy (p=0.05, Table 2). Those with active or severe IBD who had a c-section were more likely to be on no therapy or immunomodulator monotherapy (p=0.02). Women who had a c-section for perianal disease were more likely to be taking biologic therapy with or without combination immunomodulator therapy (p<0.0001). There was no association between type of drug therapy and preterm birth as an indication for cesarean section (p=0.53). In the overall population, women on combination therapy and biologic therapy had significantly increased adjusted odds of having a c-section (OR 1.7, 95% CI 1.1-2.5 and OR 1.3, 95% CI 1.0-1.8 respectively).

CONCLUSION(S): In pregnant women with IBD, the most common indication for c-section was active disease. Furthermore, women who underwent c-section for active disease were much more likely to be on no therapy. Adequate disease control both prior to conception and during pregnancy, as well as education of patients and providers on safety of vaginal delivery in healthy IBD patients, can reduce the rate of c-section in this population.