Placental Histopathological Lesions and Adverse Neonatal Outcomes in Patients with Inflammatory Bowel Diseases- A retrospective Cohort Study

Ohad Feldstein; Ann Dekalo; Liat Mor; Meital Levin; Letizia Schreiber; Yael Ganor Paz; Eran Israeli; Giulia Barda; Eran Weiner

doi:10.1007/s43032-024-01571-2

Placental Histopathological Lesions and Adverse Neonatal Outcomes in Patients with Inflammatory Bowel Diseases- A retrospective Cohort Study

Reprod Sci. 2024 Apr 25. doi: 10.1007/s43032-024-01571-2. Online ahead of print.

Authors

Ohad Feldstein^#¹, Ann Dekalo^#¹, Liat Mor², Meital Levin¹, Letizia Schreiber^{3

4}, Yael Ganor Paz^{1

4}, Eran Israeli^{4

5}, Giulia Barda^{1

4}, Eran Weiner^{1

4}

Affiliations

¹ Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.
² Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel. liatmor1@gmail.com.
³ Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel.
⁴ Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁵ Department of Gastroenterology and Liver Diseases, The Edith Wolfson Medical Center, Holon, Israel.

^# Contributed equally.

PMID: 38664358
DOI: 10.1007/s43032-024-01571-2

Abstract

Inflammatory bowel diseases (IBD) are significantly associated with adverse pregnancy and neonatal outcomes, though the pathomechanism is yet unknown. To investigate the relationship between IBD and adverse pregnancy outcomes by comparing neonatal outcomes and placental histopathology in two matched groups of patients with and without IBD. In this retrospective study, data of all patients who gave birth between 2008-2021 and were diagnosed with IBD were reviewed and compared to a control group matching two control cases for every IBD case. Neonatal outcomes and placental pathology were compared between the groups. Compared to the control group (n=76), the placentas of patients with IBD (n=36) were characterized by significantly lower placental weight (p < 0.001), and higher rates of maternal vascular malperfusion lesions (MVM, p < 0.001) and maternal and fetal inflammatory response lesions (p < 0.001). Neonates of patients with IBD were more frequently small for gestational age (SGA) (p=0.01), with increased rates of need for phototherapy (p = 0.03), respiratory morbidity and NICU admission (p < 0.001 for both outcomes). Multivariate logistic regression analyses adjusting for possible confounders (including maternal age, gestational age, chronic hypertension, smoking, and thrombophilia) confirmed the independent association between IBD and composite MVM lesions (aOR 4.31, p < 0.001), maternal inflammatory responses (aOR 40.22, p < 0.001) and SGA infants (aOR 4.31, p = 0.013). IBD is associated with increased rates of placental histopathological lesions and adverse pregnancy outcomes, including SGA infants. These novel findings imply the role of placental malperfusion and inflammatory processes in pregnancy complications of IBD patients, which should be followed accordingly. Approval of local ethics committee # WOMC-0219-20.

Keywords: Crohn’s disease; Inflammatory bowel disease (IBD); Inflammatory lesions; Neonatal outcomes; Placental pathology; Small for gestational age (SGA); Ulcerative colitis (UC).