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Open Access Research article

Importance of appropriate pharmaceutical management in pregnant women with ulcerative colitis

Masaki Ujihara1, Takafumi Ando1*, Kazuhiro Ishiguro1, Osamu Maeda1, Osamu Watanabe1, Yutaka Hirayama1, Kazuhiro Morise1, Keiko Maeda1, Masanobu Matsushita1, Ryoji Miyahara1, Naoki Ohmiya1, Yuji Nishio2, Takeo Yamaguchi3, Jun-ichi Haruta3, Kenji Ina4 and Hidemi Goto1

Author Affiliations

1 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan

2 Department of Gastroenterology, Meitetsu Hospital, Nagoya 451-8511, Japan

3 Department of Gastroenterology, Nagoya First Red Cross Hospital, Nagoya 453-8511, Japan

4 Department of Medical Oncology, Nagoya Memorial Hospital, Nagoya 468-0011, Japan

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BMC Research Notes 2013, 6:210  doi:10.1186/1756-0500-6-210

Published: 25 May 2013

Abstract

Background

Ulcerative colitis (UC) often occurs in women of childbearing age. Compared to Western countries, however, few studies have investigated the impact of UC on the progress of pregnancy in Asian populations.

Methods

We retrospectively examined 91 pregnancies in 64 patients with UC experienced at our hospital and related institutions from 1991 to 2011, focusing on the relationship between the progression of UC during pregnancy, progress of the pregnancy itself, and the treatment of UC.

Results

In 80 of 91 pregnancies the patient had already been diagnosed with UC at the time she became pregnant, of whom 31 (38.8%) experienced exacerbation during pregnancy. Regarding severity, moderate or severe active-stage disease during pregnancy was seen in 13.7% of those who had been in remission at the onset of pregnancy versus 58.6% of those who had been in the active stage at onset (OR 8.9: 95%CI 3.0~26.4; P<0.01). The incidence of miscarriage or abortion was 9.8% in pregnancies in which UC was in remission at onset versus 31% in those in which it was in the active stage at onset (OR 4.1: 95%CI 1.2~13.9; P=0.02). Among patients, 62.5% were receiving pharmaceutical treatment at onset of pregnancy. Exacerbation during pregnancy occurred in 26.5% of the group who continued to receive the same treatment during pregnancy versus 56.3% of those with a dose decrease or discontinuation after onset (OR 3.6: 95%CI 1.0~12.4; P=0.04).

Conclusions

UC patients wishing to conceive should do so when in remission and continue appropriate pharmaceutical treatment during pregnancy.

Keywords:
Ulcerative colitis; Pregnancy; Clinical course; Treatment