Predictors of hypertensive disorders of pregnancy among patients with inflammatory bowel disease

Abstract Background Inflammatory bowel disease (IBD) has been associated with the development of hypertensive disorders of pregnancy (HDP). Patients are recommended to take low‐dose aspirin (LDA), a non‐steroidal anti‐inflammatory drug (NSAID), for preeclampsia prophylaxis. However, there is reluctance to do so due to the effects of NSAIDs on IBD and pregnancy. There have not been studies on specific risk factors for preeclampsia in patients with IBD to help better stratify risk for this vulnerable population. Objective To investigate predictors of HDP in patients with IBD and evaluate the use of LDA prophylaxis. Study design This was a retrospective cohort study of all singleton pregnancies with a history of IBD who delivered at a single academic center from January 2019 to December 2023. The primary outcome was the development of HDP, including gestational hypertension or preeclampsia. Baseline characteristics, LDA use, pregnancy outcomes, and IBD disease activity during the pregnancy were collected. Results Of 100 deliveries among 89 patients with IBD, 22 (22%) were complicated by HDP. Baseline characteristics, including maternal age (36.3 years vs. 33.9 years, p = 0.06) and obesity (31.8% vs. 21.8%, p = 0.33), were not significantly different between groups. HDP was more likely to occur among patients who had a history of HDP (22.7% vs. 2.6%, p < 0.01) or concurrent gestational diabetes (18.2% vs. 3.8%, p = 0.02). Fetal fraction on cell‐free fetal DNA (cfDNA) was lower in pregnancies with HDP (8.0% vs. 10.3%, p = 0.01). HDP did not differ by clinical remission rates (86.4% vs. 85.9%, p = 0.86) or IBD flares during pregnancy (22.7% vs. 15.4%, p = 0.42). After adjustment for advanced maternal age and gestational diabetes, prior HDP remained a significant predictor (adjusted odds ratio [aOR], 6.98; 95% confidence interval [CI], 1.24–39.8). LDA for preeclampsia prevention was reported in 16% ( n = 16) of our study population and was similar in deliveries who did and did not develop HDP (22.7% vs. 14.1%, p = 0.33). Conclusion HDP occurred in over one in five pregnancies among patients with IBD and did not appear to be related to disease activity. LDA use for preeclampsia prophylaxis was low (16%) in this cohort. Further studies are needed to determine the risk‐benefit ratio of LDA use in pregnancies with IBD.