S977 Ectopic Pregnancy in Women With IBD: Experience at a Tertiary Care IBD Center

Introduction: Women with IBD often have risk factors for ectopic pregnancy (EP) including previous abdominal or pelvic surgery, pelvic sepsis or intra-abdominal adhesions. The prevalence of an ectopic pregnancy among healthy women who present to an emergency department with first trimester bleeding, pain, or both ranges from 6% to 16%. To date, the single large population-based cohort study for EP in IBD was not able to account for medication use, disease activity or severity, and was published prior to wide-spread use of anti-TNF agents in the preconception and pregnancy states. We were interested in assessing EP in our population from a tertiary care IBD center, in particular taking into account disease activity and use of biologics prior to conception. Methods: The electronic medical record was queried for legal sex females with a diagnosis of ulcerative colitis (UC), Crohn's disease (CD) or inflammatory bowel disease (IBD) and a history of a pregnancy event receiving all of their care at our tertiary care center. From this cohort the term “ectopic pregnancy” using ICD-10 code and SNOMED concepts between 1/1/13 and 2/28/2022 were used to identify our population of interest. Chart review including diagnosis, surgical history, current and previous medications, and disease activity at the time of conception was then performed. Pregnancy specific variables include age at time of conception, parity, history of previous pregnancy loss, history of Caesarean section, or endometriosis. Results: 20,624 legal sex females with CD, UC or IBD were identified and 335 patients were diagnosed with a pregnancy event with all of their care at our center. 6 patients were diagnosed with an EP. Of interest, only 4 had their EP after an established diagnosis of UC or CD. Of these 4 patients, 3 had UC and 1 had CD. Duration of disease prior to EP ranged from 6 months to 4 years. Of the 3 patients with UC, all were in remission on either aminosalicylate or anti TNF therapy. The patient with CD had mild activity, was status post one resection and on no medication at the time of the EP. None had other common risk factors for EP. Conclusion: EP in our practice was uncommon, with an incidence of only 2%. Whether this is because of improved control of disease activity or preconception counseling has yet to be determined. Larger population-based studies are needed to assess the impact of newer medical therapies and disease management on the risk of this pregnancy outcome.