Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes

Background Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter...

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Published in:Digestive diseases and sciences 2021-02, Vol.66 (2), p.577-586
Main Authors: Watanabe, Chikako, Nagahori, Masakazu, Fujii, Toshimitsu, Yokoyama, Kaoru, Yoshimura, Naoki, Kobayashi, Taku, Yamagami, Hirokazu, Kitamura, Kazuya, Takashi, Kagaya, Nakamura, Shiro, Naganuma, Makoto, Ishihara, Shunji, Esaki, Motohiro, Yonezawa, Maria, Kunisaki, Reiko, Sakuraba, Atsushi, Kuji, Naoaki, Miura, Soichiro, Hibi, Toshifumi, Suzuki, Yasuo, Hokari, Ryota
Format: Article
Language:English
Subjects:
Abortion, Spontaneous - diagnosis
Abortion, Spontaneous - epidemiology
Adult
Age
Analysis
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Biochemistry
Colitis, Ulcerative - diagnosis
Colitis, Ulcerative - drug therapy
Colitis, Ulcerative - epidemiology
Complications and side effects
Drug dosages
Drugs
Female
Gastroenterology
Hepatology
Humans
Infant, Newborn
Inflammatory bowel disease
Medical colleges
Medical research
Medical treatment
Medication Adherence
Medicine
Medicine & Public Health
Medicine, Experimental
Mesalamine - therapeutic use
Oncology
Original Article
Patient compliance
Patient outcomes
Physicians
Pregnancy
Pregnancy Complications - diagnosis
Pregnancy Complications - drug therapy
Pregnancy Complications - epidemiology
Pregnancy Outcome - epidemiology
Pregnant women
Premature Birth - diagnosis
Premature Birth - epidemiology
Prospective Studies
Questionnaires
Regression analysis
Risk factors
Surveys
Symptom Flare Up
Transplant Surgery
Tumor necrosis factor-TNF
Ulcerative colitis
Womens health
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Summary:Background Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference. Methods Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes. Results Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians’ estimate ( p  = 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928–30.427, p  = 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350–51.994, p  = 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse ( p  = 0.002). Conclusion Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-020-06221-6