April 5, 2012 — Women with irritable bowel syndrome (IBS) may be at higher risk for miscarriage and ectopic pregnancy. The collaborative study between researchers at University College Cork, Ireland, and the Biostatistics Group of the University of Manchester, United Kingdom, was published online February 27 in Clinical Gastroenterology and Hepatology.
Among 100,000 pregnant women, 26,543 (26.5%) were diagnosed with IBS before pregnancy. Of the total cohort, 6578 (6.6%) had a spontaneous miscarriage, 741 (0.74%) had an ectopic pregnancy, 425 (0.43%) developed preeclampsia, and 217 (0.22%) had a stillbirth.
Researchers noted that IBS was associated with a moderately increased risk for miscarriage (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.13 - 1.30) and ectopic pregnancy (OR, 1.28; 95% CI, 1.06 - 1.55). However, there did not appear to be an association between IBS and preeclampsia (OR, 1.09; 95% CI, 0.85 - 1.39) or stillbirth (OR, 1.00; 95% CI, 0.69 - 1.44). Young women, women who smoked, and women with no additional comorbidities who had IBS and depression/anxiety had an increased risk for miscarriage of approximately 25% to 30%.
The most commonly diagnosed gastrointestinal condition, IBS is most prevalent among women of reproductive age. "Disturbances of circulating cytokines have been implicated in both the pathophysiology of IBS and adverse pregnancy outcomes such as spontaneous miscarriage, ectopic pregnancy, preeclampsia, and stillbirth," write Ali S. Khashan, PhD, from the Anu Research Centre, Department of Obstetrics and Gynecology, University College Cork, National University of Ireland, and colleagues.
Data on the cohort of 100,000 women came from the General Practice Research Database. The women were aged 13 to 50 years. Researchers stratified the women by random sampling into 2 cohorts: women with no record of IBS or depression/anxiety, and women with a previously established diagnosis of IBS. Because of the high prevalence of depression/anxiety among women with IBS, women in the IBS cohort were further classified into those with or without a history of depression/ anxiety, so that any observed associations between IBS and pregnancy outcome were independent from these comorbidities.
In the final analysis, there were 18,159 women with a diagnosis of IBS without depression/anxiety and 8384 with IBS and depression/anxiety.
Adverse pregnancy outcomes identified included spontaneous miscarriage, ectopic pregnancy, stillbirth, and preeclampsia. Statistical models were adjusted for the following variables: maternal age, body mass index, alcohol intake, smoking, socioeconomic status, diabetes, hypertension, asthma, and other gastrointestinal diseases.
Subgroup analyses of women aged 13 to 24 years and women aged 25 to 50 years were performed to examine the potential interactions between maternal age and IBS and between smoking and IBS. Subgroup analysis of women with no additional comorbidities was also performed.
The study authors acknowledge study limitations such as possible underreporting of preeclampsia and stillbirth data, as well as a lack of information regarding the subtype and severity of IBS. The latter, note the authors, may have provided further insight into whether increased severity of IBS is associated with increased risk for pregnancy complications. In addition, the study did not explore the effect of prescribed or over-the-counter medications on the observed associations.
"The study had the advantage of a very large population-based cohort of women with well-documented IBS diagnosis and pregnancy outcomes," note the researchers. Although the biologic mechanisms behind the association between IBS and adverse pregnancy outcomes are unclear and warrant further study, "[t]hese findings indicate the importance of prenatal care for women with IBS," conclude Dr. Khashan and colleagues.
Access to the General Practice Research Database was funded through the Medical Research Council's license agreement with the Medicines and Healthcare Products Regulatory Agency. Dr. Khashan and 1 coauthor are funded by the Health Research Board of Ireland. The other authors have disclosed no relevant financial relationships.
Clin Gastroenterol Hepatol. Published online February 27, 2012. Abstract
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