Highlighting Disparities and Outcomes in Pregnant Patients With Inflammatory Bowel Disease (IBD): Does Race Matter?

Background: Inflammatory bowel disease (IBD) encompasses both Ulcerative Colitis and Crohn’s Disease, which are two chronic conditions that can lead to complications in women who are pregnant. Active IBD has been associated with an increased risk of preterm birth, fetal loss, and low gestation weight. Women with IBD can have healthy pregnancies, however, these patients are more likely to have complications. This study compares the inpatient hospitalization outcomes in pregnant patients with IBD compared to non-pregnant IBD patients. Methods: We retrospectively analyzed the Nationwide Inpatient Sample (HCUP-NIS) 2015-2020 database. Patients aged 18 years and above with diagnoses of (Inflammatory Bowel Disease) IBD and anxiety were identified using ICD-10 codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Various parameters were analyzed using propensity matching utilizing the Kernel Method. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Primary outcomes, included inpatient mortality, total hospital charges (TOTCH), and length of stay (LOS). Results: We identified 3,608,001 pregnant patients with IBD and 289,304 patients with IBD only. There were no statistically significant differences in primary outcomes between both patient populations. However, In pregnant patients with IBD, positive predictors of increased mortality were Native American race (OR 3.16, P< 0.04, CI: 1.98-5.79) and those with coronary artery disease (CAD) (OR 3.39, P< 0.04, CI 1.96-6.97). Furthermore, the presence of a fistula led to increased LOS (+2.37, p= 0.00, CI: 1.96 -2.78) and TOTHC ($24,523.15, p= 0.00, CI: $19145.14-$ 29901.16) in these patients (+2.37, p= 0.00, CI: 1.96-2.78). Total hospital charges were increased in pregnant patients with IBD if they had concomitant CAD ($29,410.49, p= 0.01, CI: $6,183.47- $52,637.52). Conclusions: Our study surprisingly revealed that the presence of pregnancy in patients with IBD does not worsen mortality, TOTHC, or LOS when compared to non-pregnant patients with IBD. However, we found that pregnant Native Americans with IBD have worse inpatient mortality. Native American women are also at risk for health disparities and complications related to pregnancy given a lack of prenatal health care. Thus, these patients require specialized complex care to avoid the adverse outcomes associated with IBD. Future studies are warranted to assess these outcomes given there is extremely limited data about this patient population.