Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2017; 23(45): 8082-8089
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.8082
Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis
Begoña Gonzalez-Suarez, Shreyashee Sengupta, Alan C Moss
Begoña Gonzalez-Suarez, Shreyashee Sengupta, Alan C Moss, Division of Gastroenterology, Inflammatory Bowel Disease Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Author contributions: Gonzalez-Suarez B, Sengupta S acquisition of data, data analysis, drafting the manuscript; Moss AC study concept and design, critical revision of the manuscript for important intellectual content, statistical analysis, study supervision.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alan C Moss, MD, Division of Gastroenterology, Inflammatory Bowel Disease Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States. amoss@bidmc.harvard.edu
Telephone: +1-617-667-3197
Received: May 27, 2017
Peer-review started: June 1, 2017
First decision: June 23, 2017
Revised: July 7, 2017
Accepted: August 9, 2017
Article in press: October 24, 2017
Published online: December 7, 2017
Processing time: 42 Days and 0.1 Hours
Abstract
AIM

To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease (IBD).

METHODS

Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight (LBW) or small for gestational age (SGA) among pregnant women with IBD. Sixty-nine abstracts were identified, 35 papers were full text reviewed and, only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.

RESULTS

This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria, and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD, when compared with women in remission: 1.3 for SGA (4 studies, 95%CI: 1.0-1.6, P = 0.04) and 2.0 for LBW (4 studies, 95%CI: 1.5-2.7, P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW (RR 1.4, 95%CI: 1.1-1.9, P = 0.007) compared with non-treated women, but when adjusted for disease activity there was no significant effect on LBW (RR 1.2, 95%CI: 0.6-2.2, P = 0.6). No differences were observed regarding SGA (2 studies; RR 0.9, 95%CI: 0.7-1.2, P = 0.5).

CONCLUSION

Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

Keywords: Pregnancy; Inflammatory bowel disease; Thiopurines; Disease activity; Low birth weight; Small for gestational age

Core tip: There are conflicting data on the impact of disease activity and thiopurine use on birth weight in pregnant women with inflammatory bowel disease. The individual impact of these factors in low birth weight (LBW) and small gestational age (SGA) has not been systematically evaluated to date. For these reasons, we performed a meta-analysis to identify the effect of disease activity or thiopurine use on the rates of LBW and SGA in these patients. Since many women become non-adherent to medications during pregnancy, for fear of a negative effect on the fetus, further information would be useful in counseling women.