Pregnancy Outcomes in a Cohort of Patients with Inflammatory Bowel Disease: Data from a Multidisciplinary Clinic in a Tertiary Center

BACKGROUND

Inflammatory bowel disease (IBD) can have an impact on pregnancy outcomes due to the effect of the disease activity and medication use. This study aimed to evaluate the pregnancy outcomes in IBD patients treated at a multidisciplinary clinic.

METHODS

This study was a retrospective cohort study including consecutive pregnant patients with IBD having a singleton gestation attending a multidisciplinary clinic between 2012 and 2019. The IBD activity and management throughout gestation were assessed. The pregnancy outcomes included: adverse neonatal and maternal outcomes, mode of delivery, and three integrative outcomes: (1) a favorable pregnancy outcome, (2) a poor pregnancy outcome, and (3) an unfavorable maternal outcome. The IBD pregnant cohort was compared with a cohort of non-IBD pregnant women delivering at the same shift. Multivariable logistic regression was used for risk assessment.

RESULTS

Pregnant women with IBD (141) and without (1119) were included. Mean maternal age was 32 [±4] years. Patients with IBD had a higher rate of nulliparity (70/141 (50%) vs. 340/1119 (30%), p < 0.001) and lower BMI (21.42 kg/m² (19.18-23.44) vs. 22.48 (20.31-25.59), p = 0.002). All the other characteristics were comparable. Most patients with IBD 124/141 (88%) were in clinical remission at conception; with maintenance therapy in 117/141 patients (83%). A third of the patients, 43/141 (30.5%), were treated with biologics. Exacerbation occurred during pregnancy in 51/141 (36%). The majority of the maternal and neonatal outcomes and all the composite outcomes were comparable between the patients with IBD and the women without IBD. Cesarean delivery was more frequent in patients with IBD (49/141 (34.8%) vs. 270/1119 (24.1%), p = 0.021). IBD was not associated with composite outcomes.

CONCLUSIONS

In pregnant patients with IBD followed at a multidisciplinary clinic, the pregnancy outcomes were encouraging and comparable to those of the women without IBD.

Fatty acid composition of human milk in Kuwaiti mothers

Kuwaiti diet is exceptionally rich in fat, carbohydrates and proteins. In addition, subjects in Kuwait are exposed to extreme heat and sun light. Fatty acid profiles of human milk obtained from 19 full breast feeding Kuwaiti mothers were analyzed. Dietary patterns for individual mothers were determined by 24 h dietary recall and food frequency questionnaire. The fatty acid content of human milk was affected by the diet consumed by the lactating mother. The content of long chain polyunsaturated fatty acids (LCP) in human milk lipids did not correlate with their parent fatty acids like linoleic and alpha-linolenic acids. However the human milk LCP were related to the of content of LCP in the maternal diet. Mothers reporting a high fish consumption showed significant amounts of C22:6, omega 3 and C20:5, omega 3 fatty acids. As a general conclusion, breast milk produced by a well nourished mother is better suited to meet the lipid requirements of infants.

Evidence for the presence of a reversible Ca2+-dependent pore activated by oxidative stress in heart mitochondria

Rat heart mitochondria became permeabilized to sucrose when incubated with 100 nmol of Ca2+/mg of protein in the presence of Pi. Ca2+ chelation with EGTA restored impermeability to sucrose, which became entrapped in the matrix space. t-Butylhydroperoxide markedly promoted permeabilization in the presence of Ca2+ but not in its absence, and Ca2+-plus-t-butylhydroperoxide-induced permeabilization was reversed by EGTA. The data suggest that Ca2+ and oxidative stress synergistically promote the reversible opening of an inner membrane pore.