Marla Dubinsky, MD, on PIANO Lessons in Pregnancy

In this podcast, Marla Dubinsky, MD, discusses highlights from her presentation on Pregnancy and Inflammatory Bowel Disease, and Neonatal Outcomes—Lessons in Pregnancy, during the AIBD Regional virtual conference.

Marla Dubinsky, MD, is the codirector of Susan and Leonard Feinstein IBD Clinical Center at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

TRANSCRIPT

Dr. Marla Dubinsky:  Hello, I'm Dr. Marla Dubinsky from the Icahn School of Medicine. I would like to take this opportunity to review some of the key highlights from the lecture that I gave entitled, "Pregnancy and Inflammatory Bowel Disease, and Neonatal Outcomes—Lessons in Pregnancy."

The bulk of my talk was focused on bringing you the data that we reported in the PIANO study, and speak about the safety of our therapies for use in women who are considering pregnancy, and while pregnant, and postpartum.

First, we set the stage to say that we know that there's a lot of misinformation and misperception around reproductive health among IBD patients.

We know, due to fears of therapies more than anything, and/or the impact of IBD on pregnancy outcomes often leads to our female patients being concerned about even getting pregnant, and even thinking at some level that they may have difficulty getting pregnant.

We know that priorities for patients who are thinking about pregnancy are focused on, "Can I get pregnant? Will my disease be active? How will my disease impact my baby?" and most importantly, "Can I take my medication safely during pregnancy as it relates to breastfeeding?"

What we do know from the PIANO study, which is one of the largest prospectively-acquired information in women who are pregnant as it relates to therapies, specifically, we looked at patients on biologics alone, thiopurines alone, combination of biologics and thiopurines, and none of those.

There were some important key findings that I want to share with you. The good news is that no matter at what time in the pregnancy, we looked at infections at birth, we looked at infections in the babies at four months of life, we looked at infections in the baby at first year of life.

The good news is that there was no increased risk of infections, whether the babies were exposed in utero to biologics, thiopurines, combination of biologics and thiopurines, or no exposure to therapy. We also know that there was no increase in congenital malformations, spontaneous abortions, preterm birth, or low birth weight tied to exposure to our medications.

We did see, however, of course, that infections are increased in babies who have preterm delivery, but again, we know from a lot of data that preterm delivery is associated with uncontrolled inflammation. Therefore, the importance even more of needing our female patients to stay on their medications during pregnancy.

What's more important is the concern about the medication causing adverse events may lead to women stopping their medications, and/or their OB recommending stopping their medications, or in some times, gastroenterologists recommending stopping the medications.

We know that disease activity, meaning ongoing inflammation is associated with increased spontaneous abortion. It's very important for our patients to know that our medications are safe, and what isn't healthy for the baby and for pregnancy is ongoing disease activity.

We also showed, in addition to infections and congenital anomalies not being associated with the therapies, particularly biologics or exposure even in the third trimester, is there is no negative impact of drug exposure on development. Fine motor skills, speech, any other type of development was not impacted by the medication the baby was exposed to during in utero.

All around great news that came out of the PIANO study. We know that it's a very emotional topic to talk to moms about IBD and pregnancy, and getting mums ready before they get pregnant to tell them all of this information is the key to a healthy pregnancy and a healthy postpartum period. Thank you.