S2019 Clinical Predictors of Hospitalizations During Pregnancy in Patients With Inflammatory Bowel Disease

Introduction: Fifty percent of patients with inflammatory bowel disease (IBD) are less than 35 years old at the time of diagnosis and 25 percent of women conceive for the first time after their diagnosis. Previous studies have shown that pregnant women with IBD are at increased risk of poor outcomes including hospitalizations compared with those without IBD; however, there is currently a lack of studies evaluating the risk factors for hospitalizations among this population. Therefore, we aimed to investigate the predictors for hospital admissions in pregnant women who have IBD. Methods: The IBM MarketScan Research Database ® was queried using the International Classification of Diseases, Tenth Edition Clinical Modification diagnostic codes from January 2016 to December 2022. Pregnant women (age ≥18) with a diagnosis of ulcerative colitis or Crohn’s disease were eligible for inclusion. Univariable analysis compared the population of pregnant women with IBD who were admitted vs those who were not. Baseline patient characteristics included age, region, Charlson Comorbidity Index (CCI), duration of pregnancy, infections, anxiety, depression, tobacco use, presence of fistula, maternal-fetal outcomes, and use of biologic therapy and/or corticosteroid therapy during pregnancy. Multivariable analysis assessed predictors of hospital admission for pregnant women with IBD. Results: We identified 18,931 pregnant IBD patients including 1,090 who had at least one hospitalization during pregnancy. Rates of hospitalization were higher in patients with anxiety, depression, fistula formation, tobacco abuse, corticosteroid use, and pneumonia or Clostridioides difficile (C. diff) infections. Higher rates of adverse maternal-fetal outcomes were observed in the hospitalized group. Patients with higher CCI, corticosteroid therapy, C. diff, pneumonia, anxiety, depression, tobacco abuse, or presence of a fistula were more likely to be admitted during their pregnancy. The largest effects were C. diff (OR: 7.51; 95% CI: 5.02-11.22), pneumonia (OR: 5.23; 95% CI: 3.47-7.89), tobacco abuse (OR: 3.04; 95% CI: 2.42-3.84), and presence of a fistula (OR: 2.29; 95% CI: 1.72-3.04). Conclusion: Pregnancy poses a unique challenge for women with IBD. Using the IBM MarketScan Research Database ®, we identified risk factors associated with unplanned hospitalizations for pregnant women with IBD. These findings can help providers identify and treat patients at risk for potentially preventable hospitalizations.