Uma Mahadevan, MD, on C-section Among Women with IBD

In this video, Dr Mahadevan reviews information presented at the Advances in Inflammatory Bowel Disease 2020 virtual meeting on data from the PIANO study concerning Cesarian sections among women with inflammatory bowel disease.

Uma Mahadevan, MD, is a professor of medicine at the University of California at San Francisco and codirector of the UCSD Center for Colitis and Crohn’s Disease.

TRANSCRIPT

Hello, I am Uma Mahadevan, a professor of medicine at the University of California San Francisco. My colleague Sara Lewin and the PIANO investigators, including Dr. Millie Long, presented our data at the AIBD meetings on Cesarean section in women with inflammatory bowel disease.

This was from the PIANO or Pregnancy in Inflammatory bowel disease in Neonatal Outcomes registry. Among 1,490 women who had a pregnancy in the registry of which we know the outcome, 1,431 had a live birth. There was a 40 to 44% rate of Cesarean section in this group, which is much higher than the national average of 31%.

Things that drove this higher rate of Cesarean section were primarily disease activity, including perianal disease. While there was also an increase in elective Cesarean section among biologic-exposed patients, the majority of the Cesarean sections were done for active disease, including this perianal disease.

Among those patients, the majority were not on biologic therapy. The lessons we can take away from this to reduce the rate of unnecessary Cesarean section in this population is to, one, control the disease activity well, particularly among patients with perianal disease, as well as ulcerative colitis who may not be on adequate biologic therapy.

Two, we should educate our obstetric colleagues that Cesarean section is not necessary for the patient with inflammatory bowel disease in remission for GI indications.

Overall, the PIANO data does show that biologic and bioappearing therapy throughout pregnancy is safe. With this knowledge and with controlling disease activity better, we can reduce the rate of unnecessary Cesarean section in this population.