P152 Fertility and reproduction in a tertiary IBD centre: the Oxford experience

Abstract

Background: Inflammatory bowel disease (IBD) commonly affects women during their childbearing years. Published data suggest that observed low fertility rates in IBD are due to voluntary childlessness and quiescent IBD does not confer decreased fertility. Active IBD at conception is reportedly associated with higher rates of preterm birth, low birth weight, and caesarean section (C-section). Reproductive choices and outcomes relating to fertility and pregnancy remain important concerns in IBD populations. The Oxford University Hospitals (OUH) NHS Foundation Trust is a tertiary centre with >8500 deliveries per year and >3500 IBD patients. All pregnant IBD patients are referred to the Silver Star obstetrics medical team. The Oxford IBD service aims to impart accurate pregnancy information and provides a comprehensive information booklet. We present our recent reproductive outcomes in IBD. We compared IBD conception, termination rates, and pregnancy outcomes with local and national data, and in the context of IBD phenotype. Method(s): Women aged 15-55 years with IBD from January 2012 to May 2016 were identified via the IBD database. ICD codes identified miscarriage, ectopic pregnancy, termination, delivery mode, and outcomes. Comparative analysis was performed. Result(s): A total of 1127 women aged 15-55 years with IBD are cared for at OUH. The total cohort is 240 women who had 323 pregnancies. IBD pregnant women demonstrate reduced anti-TNF use and surgery, and are more frequently on no medication than age-and sex-matched IBD. Conception rates (43.1 vs. 76.1 per 1000 women) markedly differ from a healthy population. Our IBD patients exhibit no difference in gestation, birthweight or the majority of pregnancy-related outcomes. Cholestasis of pregnancy rates are markedly different (6.9% vs. 0.32-0.58%) despite no association with PSC. Women with IBD are more likely to deliver by C-section (41% vs. 23%). Conclusion(s): Our IBD population has comparative pregnancy outcomes to healthy controls, the exceptions being C-section rates and cholestasis of pregnancy. Conception rates in our IBD population remain low compared with healthy controls.