Chronic pancreatitis in pregnant women is associated with an increased risk for complications, such as gestational diabetes, hypertension, and premature delivery, according to a study in Digestive and Liver Disease.
The retrospective analysis is based on hospital discharge records from the US National Inpatient Sample (NIS) database from 2009 to 2019.
Primary maternal outcomes included death; gestational diabetes; postpartum hemorrhage; hypertensive complications, such as preeclampsia, eclampsia, or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome; and cesarean delivery. Perinatal primary outcomes were premature delivery, small for gestational age, large fetal for gestational age, and fetal death.
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The analysis included 3,094 pregnancies with chronic pancreatitis and 40,884,565 pregnancies without chronic pancreatitis. Women with chronic pancreatitis had a mean [SD] age of 29.8[0.24] years vs 28.6[0.02] years in those without chronic pancreatitis. Most of the women (64.4%) with chronic pancreatitis were White.
Pregnant women with chronic pancreatitis and a history of chronic renal failure had the highest odds of gestational hypertensive complications (odds ratio [OR], 20.09; 95% CI, 2.07-194.93), followed by those who had obesity (OR, 2.31; 95% CI, 1.02-5.22), used recreational drugs (OR 2.66; 95% CI, 1.19-5.95), and who consumed alcohol (P <.01).
The incidence of chronic pancreatitis in pregnancy during the study period was consistent, with an annual rate of 4.4 to 9.4 cases per 100,000 pregnancies. No maternal deaths were reported from 2009 to 2019. Fetal mortality in patients with chronic pancreatitis during delivery hospitalizations fluctuated, with a rate of fetal death of 21.9 per 1000 patients in 2009, 17.9 per 1,000 patients in 2017, and 0 recorded in 2018 and 2019.
Women with chronic pancreatitis had a higher risk for gestational hypertensive complications, including preeclampsia, eclampsia, and HELLP syndrome vs those without chronic pancreatitis (adjusted OR [AOR], 2.48; 95% CI, 1.87-3.29). They also had an increased risk for gestational diabetes (AOR, 1.63; 95% CI, 1.19-2.23).
Women with chronic pancreatitis had increased odds of cesarean delivery vs those without the condition (AOR, 1.35; 95% CI, 1.09-1.66). Women with chronic pancreatitis also had a higher rate of preterm labor (AOR, 3.10; 95% CI, 2.40-4.00) and small for gestational age (AOR, 2.40; 95% CI, 1.35-3.08).
Patients with alcohol-induced chronic pancreatitis had more than a 3-fold increased risk for gestational diabetes (OR, 3.48; 95% CI, 1.16-10.47), a 4-fold increased risk for preterm birth (OR, 4.05; 95% CI, 1.1-13.91), and a 17-fold increased risk for fetal death (OR, 17.15; 95% CI, 2.29-128.26), compared with patients without chronic pancreatitis.
Women with chronic pancreatitis were also more likely to have Medicaid (OR, 1.46; 95% CI, 1.23-1.73) and Medicare (OR, 6.50; 95% CI, 4.30-9.82) insurance.
Among several limitations, the data were obtained from the NIS, which is based on administrative claims, and more detailed information regarding medication use was not available. The NIS database also lacks more detailed information on laboratory results, gestational age, or severity of pancreatitis, and it does not include follow-up clinical information.
“The findings of this study highlight the importance of addressing health disparities and ensuring access to resources and care for individuals with chronic pancreatitis,” study authors wrote. “Pregnant women with chronic pancreatitis should be under the care of a multidisciplinary team of health care providers, including an obstetrician, gastroenterologist, dietitian, and specialist in pain management.”
Reference
Niu C, Zhang J, Zhu K, Liu H, Okolo PI 3rd. The hidden dangers of chronic pancreatitis in pregnancy: evidence from a large-scale population study. Dig Liver Dis. Published online July 18, 2023. doi:10.1016/j.dld.2023.07.001
This article originally appeared on Gastroenterology Advisor
