DOP042Dedicated Joint Inflammatory Bowel Disease-Antenatal clinics are associated with better pregnancy and neonatal outcomes in patients with active Inflammatory Bowel Disease during pregnancy: results from a large UK multi-centre cohort

Background Active inflammatory bowel disease (IBD) during pregnancy is associated with an increased risk of adverse outcomes. Identifying predictors can inform targeted interventions. Methods A multi-centre retrospective cohort study was conducted across 16 UK sites, 8 of which offered a joint IBD-antenatal clinic. Pregnant patients with active IBD defined by clinical symptoms and/or elevated FCP (≥250 μg/g) or CRP (≥5 mg/L) - and either (i) change in IBD therapy (ii) IBD-related hospitalisation or (iii) IBD related surgery were included. Composite endpoints were: a. Adverse IBD outcome; IBD related hospitalisation or luminal surgery during pregnancy. b. Adverse pregnancy or neonatal outcome; 1 of spontaneous pregnancy loss, small-for-gestational-age infant, fetal growth restriction, low birth weight (<2500g), preterm birth (<37 weeks gestation), maternal or neonatal infection requiring antibiotics, APGAR score <7 at 5 minutes, NICU admission, or congenital defect. Logistic regression and multivariate analyses adjusted for maternal age, BMI, and smoking status at conception, to determine a relative risk ratio (RRR). Results Three hundred and ninety-nine pregnancies were included. Active disease was predominantly detected in the second trimester (55.4%) with a median (IQR) CRP of 9 (5-20) mg/L and FCP 600(438-1350) μg/g. Adverse IBD outcomes occurred in 23.1% (n = 92) with 91 patients having an IBD related hospitalisation and 6 patients undergoing luminal surgery in pregnancy. Predictors included prior bowel resection (RRR 3.78, 95% CI 1.59–9.0; p = 0.003), prior exposure to ≥ 3 biologics (RRR 3.91, 95% CI 1.47–10.35; p = 0.006), moderate–severe disease at pre-conception (RRR 2.98, 95% CI 1.24–7.12; p = 0.014) or at flare onset (RRR 2.94, 95% CI 1.04–8.27; p = 0.041). Initiation of corticosteroids (RRR 7.24, 95% CI 3.85–13.62; p < 0.0005) or biologics (RRR 2.85, 95% CI 1.45–5.61; p = 0.002) during pregnancy were also associated with adverse IBD outcomes. An Adverse pregnancy or neonatal outcome occurred in 33.3% (n = 133), associated with persistence of active disease post-induction of definitive therapy (RRR 1.29, 95% CI 1.04-5.30; p = 0.039) and emergency caesarean section (RRR 3.13, 95% CI 1.56–6.26; p = 0.001). Management in a joint IBD-antenatal clinic was protective (RRR 0.40, 95% CI 0.22–0.72; p = 0.002), with a lower rate of adverse PAN outcomes compared to single speciality clinics (29.4% vs 50.7%, p < 0.001). Conclusion This study highlights a high-risk cohort requiring personalised pre-conception counselling and enhanced monitoring in pregnancy. Care within a dedicated IBD-antenatal clinic was associated with a lower rate of adverse outcomes, supporting embedding of this multidisciplinary model as standard of care for management of IBD in pregnancy. Conflict of interest: Shah, Krishna: No conflict of interest Dalrymple, Kathryn: No conflict of interest Rellou, Sofia: No conflict of interest Selinger, Christian Philipp: No conflict of interest Yeo, Jie Han: No conflict of interest Maxfield, Dominic: No conflict of interest Limdi, Jimmy: No conflict of interest Johnston, Emma: Nil Kefayat, Amirhosein: No conflict of interest Thoua, Nora: No conflict of interest Thakor, Amit: No conflict of interest Kent, Alexandra: I have received honoraria/Consultancy/Sponsorship fees from: Lilly, AbbVie, Coloplast, J & J, Pfizer, Takeda, Tillotts, Dr Falk, Galapagos/AlfaSigma Hicks, Lucy: No conflict of interest Cooney, Rachel: No conflict of interest Sebastian, Shaji: Grant: Takeda, Tillots pharma, Biogen, Pfizer, Abbvie, Johnson & Johnson, Olympus -Odin Vision Personal Fees: Tillots, Johnson & Johnson, Olympus Odin Vision, AbbVie, Takeda, Merck, Pharmacosmos, Amgen, Eli Lilly, BMS, Odin Vision Non-financial Support: Tillots, Takeda, AbbVie, Celltrion, Johnson & Johnson, Eli Lilly, Alphasigma, Ferring Pharma Braddy-Green, Cameron: No conflict of interest Gordon, Hannah: Personal Fees: Speaker fees : Janssen (J & J), Ferring, Takeda, AbbVie, Lilly Consultancy fees: AbbVie, Galapagos, Janssen (J & J), Takeda, Lilly Jawad, Noor: No conflict of interest Kaler, Mandeep Kaur: No conflict of interest Parkes, Gareth: No conflict of interest Lindsay, James O: No conflict of interest Kok, Klaartje: Speaker or advisory fees or support for attending conferences from Abbvie, Janssen, Takeda, Galapagos, Lilly, Falk.