BACKGROUND There are differences in the efficacy and safety profiles of medications used to treat IBD that may impact a woman's perceived risk of medication exposure during pregnancy, potentially leading to medication non-adherence, poor disease-control and adverse pregnancy outcomes. AIM To assess whether medication adherence patterns differ by drug class during pregnancy and influence birth outcomes for women with IBD. METHODS Of 143 491 women, a validated case definition was used to identify 370 women with IBD in five administrative health databases in Alberta, Canada (2012-2015). Women who had ≥2 consecutive medications prescription for maintenance therapy for IBD in the year prior to pregnancy were included (n = 230). Prescription-based medication possession ratio ≥0.8 defined adherence. Chi-squared tests were used to compare adherence patterns by drug class and outcomes. RESULTS Of the 159/230 women who were adherent during the year prior to pregnancy, 20 (12.6%; 95% CI: 8.2%, 18.8%) were not adherent and 21 (13.2%; 95% CI: 8.7%, 19.5%) discontinued their medications during pregnancy. Medication adherence during pregnancy differed significantly by drug class. A greater proportion of women on biologics (41.5%; 95% CI 32.9%, 50.7%) were adherent during pregnancy than women on thiopurines (22.9%; 95% CI 16.1%, 31.5%; P = 0.006); adherence was not significantly different for 5-aminosalicylates (35.6%; 95% CI 27.4%, 44.8%; P = 0.204). Women were more likely to be adherent to biologics (49.3%, 95% CI 37.3%, 61.3%) than thiopurines (20.9%; 95% CI 12.6%, 32.6%; P = 0.014) and 5-aminosalicylates (29.9%; 95% CI 19.9%, 42.1%; P = 0.030) in the first trimester. This was similar in the third trimester. In the second trimester, adherence pattern did not significantly differ by drug class (biologics vs thiopurines: P = 0.348; biologics vs 5-aminosalicylate: P = 0.999). Infants born to women with IBD (adherent: RR 1.58. 95% CI 1.02, 2.27; non-adherent: RR 1.32, 95% CI 0.97, 1.81) were more likely to be admitted into the neonatal intensive care unit than the general obstetric population, but this was not significantly different between women who were adherent or not adherent to their IBD medication (P = 0.711). CONCLUSION Almost a quarter of women with IBD who were previously adherent to medical therapy were not adherent during pregnancy. Adherence pattern differed by drug class.

中文翻译：

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与其他药物相比，患有IBD的孕妇更可能坚持生物疗法。

背景技术用于治疗IBD的药物的功效和安全性方面存在差异，这可能会影响妇女在怀孕期间感觉到的药物暴露风险，从而可能导致药物不依从，疾病控制不良和不良妊娠结局。目的评估妊娠期间药物依从性模式是否因药物类别而异，并影响IBD女性的分娩结局。方法在加拿大艾伯塔省（2012-2015年）的五个行政卫生数据库中，使用经验证的病例定义对143491名妇女进行了鉴定，以鉴定370名患有IBD的妇女。包括在怀孕前一年连续≥2种用于IBD维持治疗的药物处方的妇女（n = 230）。基于处方的药物拥有率≥0.8定义的依从性。卡方检验用于按药物类别和结果比较依从性模式。结果159/230名孕妇在怀孕前一年中依从，其中20名（12.6％; 95％CI：8.2％，18.8％）未依从，21名（13.2％; 95％CI：8.7％，19.5％） ）在怀孕期间停药。怀孕期间的药物依从性因药物类别而有显着差异。怀孕期间依从生物制剂的女性比例较高（41.5％； 95％CI 32.9％，50.7％），比使用硫嘌呤的女性比例更高（22.9％； 95％CI 16.1％，31.5％； P = 0.006）；5-氨基水杨酸酯的依从性没有显着差异（35.6％； 95％CI 27.4％，44.8％； P ＝ 0.204）。与硫嘌呤（20.9％; 95％CI 12.6％，32.6％; P = 0.014）和5-氨基水杨酸酯（29.9％; 95）相比，女性更有可能坚持使用生物制剂（49.3％，95％CI 37.3％，61.3％）。 ％CI 19.9％，42.1％; P = 0。030）。在孕晚期也是如此。在孕中期，依从性模式在药物类别上没有显着差异（生物制剂与硫代嘌呤：P = 0.348；生物制剂与5-氨基水杨酸酯：P = 0.999）。与普通产科人群相比，IBD妇女出生的婴儿（依从性：RR 1.58。95％CI 1.02，2.27；非依从性：RR 1.32，95％CI 0.97，1.81）更可能被新生儿重症监护病房收治。 ，但依从性或不依从性IBD药物的女性之间无显着差异（P = 0.711）。结论先前坚持药物治疗的IBD妇女中有将近四分之一在怀孕期间没有依从性。依从性因药物类别而异。依从性模式在药物类别上没有显着差异（生物制剂与硫嘌呤类药物：P = 0.348；生物制剂与5-氨基水杨酸酯：P = 0.999）。与普通产科人群相比，IBD妇女出生的婴儿（依从性：RR 1.58。95％CI 1.02，2.27；非依从性：RR 1.32，95％CI 0.97，1.81）更可能被新生儿重症监护病房收治。 ，但依从性或不依从性IBD药物的女性之间无显着差异（P = 0.711）。结论先前坚持药物治疗的IBD妇女中有将近四分之一在怀孕期间没有依从性。依从性因药物类别而异。依从性模式在药物类别上没有显着差异（生物制剂与硫嘌呤类药物：P = 0.348；生物制剂与5-氨基水杨酸酯：P = 0.999）。与普通产科人群相比，IBD妇女出生的婴儿（依从性：RR 1.58。95％CI 1.02，2.27；非依从性：RR 1.32，95％CI 0.97，1.81）更可能被新生儿重症监护病房收治。 ，但依从性或不依从性IBD药物的女性之间无显着差异（P = 0.711）。结论先前坚持药物治疗的IBD妇女中有将近四分之一在怀孕期间没有依从性。依从性因药物类别而异。非依从性：与普通产科人群相比，新生儿重症监护病房更容易接受RR 1.32、95％CI 0.97、1.81），但是依从性或不依从性IBD药物的女性之间无显着差异（P ＝ 0.711）。结论先前坚持药物治疗的IBD妇女中有将近四分之一在怀孕期间没有依从性。依从性因药物类别而异。非依从性：与普通产科人群相比，新生儿重症监护病房更容易接受RR 1.32、95％CI 0.97、1.81），但是依从性或不依从性IBD药物的女性之间无显着差异（P ＝ 0.711）。结论以前坚持药物治疗的IBD妇女中有将近四分之一在怀孕期间没有依从性。依从性因药物类别而异。