Crohn's disease, pregnancy, and birth weight

OBJECTIVE: Although there is general agreement that conception should be av oided when Crohn's disease is active, many questions remain unanswered for the woman with Crohn's disease in remission who becomes pregnant. METHODS: Sixty-five charts of women with Crohn's disease quiescent at the s tart of pregnancy were identified between January 1993 and December 1997. E ach pregnancy was matched to a healthy control pregnancy by date, age, pari ty, smoking status, and gestational age +/- 1 wk, and comparisons were carr ied out using matched analyses. RESULTS: The two groups were similar in terms of maternal height, weight, a nd body mass index (BMI), in addition to the matched variables. The inciden ce of pregnancy complications was similar for most of the complications exa mined, whereas the incidence of poor maternal weight gain differed signific antly between the groups (17/65 vs 2/65, p < 0.001). Flare-up of the Crohn' s disease was seen in 13/65 (20%) of pregnancies. The greatest differences in neonatal outcomes were in terms of birth weight (3150 +/- 80 g vs 3500 /- 60 g) and birth weight percentile (36.7% +/- 3.6% vs 57.5% +/- 3.4%). Ov erall, there were 16 (24.6%) small for gestational age (SGA) births in the Crohn's group, compared with only one (1.5%) in the control group (p = 0.00 07). Multivariate analysis was performed to identify factors predictive of SGA births in the Crohn's group. Ileal Crohns disease was a statistically s ignificant predictor (p = 0.035), whereas previous bowel resection trended toward statistical significance (p = 0.065). CONCLUSIONS: In view of the risk of low birth weight, all women with Crohns disease who become pregnant should be followed carefully during the pregna ncy, particularly those who have ileal disease or who have previously under gone bowel resection. Furthermore, smoking cessation needs to be aggressive ly pursued in these patients. (C) 2000 by Am. Cell. of Gastroenterology.