(083) Treatment Patterns Before, During, and After Pregnancy in Inflammatory Bowel Disease

Publication Number: 1078

Background: Women with inflammatory bowel disease (IBD) may need medical treatment during pregnancy. Examining treatment patterns in the real-world setting is important for the design of observational studies of patients with IBD during pregnancy.

Objectives: To describe patterns of IBD treatment before, during, and after pregnancy in women with IBD (ulcerative colitis [UC] and Crohn’s disease [CD]).

Methods: Data in the IBM® MarketScan® Commercial and Multi-state Medicaid Database between January 1, 2017 and December 31, 2021 was used to identify women of childbearing age (15-44 years), diagnosed with UC or CD using two diagnosis codes at least seven days apart and who have evidence of pregnancy that occurs on or after January 1, 2017. Index is defined as the date of the last menstrual period (LMP); pregnancy episodes were identified using diagnosis codes indicating gestational weeks or pregnancy outcome. Patient characteristics (demographics, comorbidities, medication use), exposure to IBD medications (biologics, systemic corticosteroids, immunomodulators, aminosalicylates) during pregnancy, in the year before (preconception), and in the year after (postpartum) pregnancy. Exposure to biologics and systemic corticosteroids and estimated duration of exposure during pregnancy were described.

Results: A total of 2143 patients with UC and 2418 patients with CD were identified; the mean age at LMP was 32 years in UC and 31 in CD. The use of IBD medications decreased during pregnancy relative to preconception and postpartum periods with the highest decline in systemic steroids (in UC: 36.4%, 14.7%, and 23.7% in preconception, during pregnancy, and postpartum, respectively). The most used IBD medications during pregnancy were aminosalicylates in UC (35.6%) and biologics in CD (32.8%). Utilization of biologics and systemic steroids decreased as pregnancy progressed with lowest levels in the 3rd trimester of pregnancy. In CD, biologics use decreased from 29.4% to 21.1% to 16.8% during the first, second and third trimesters, respectively. In UC, systemic corticosteroid use decreased from 8.4% to 5.3% to 4.6% in the first, second and third trimesters, respectively.

Conclusions: The frequency and type of medications used to manage IBD vary by pregnancy status. Biologics use decreases over trimesters during pregnancy. Descriptive treatment pattern information can be used to inform the design of studies that evaluate the safety of medications during pregnancy.