Use of medications to treat inflammatory bowel diseases before and during pregnancy in Switzerland between 2012 and 2019: an observational study using the claims-based MAMA cohort

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BACKGROUND: Effective management of Inflammatory bowel diseases (IBD) before and during pregnancy is crucial as women with well-controlled IBD at conception tend to remain in remission throughout pregnancy, experiencing outcomes similar to women without IBD. Most IBD medications are considered safe during pregnancy, except for methotrexate. Despite reassuring data, previous studies have highlighted that women often have negative perceptions and fears related to IBD medications, leading to poor adherence. There is a lack of data regarding how IBD is treated before and during pregnancy in Switzerland. We aimed to assess the prevalence and usage patterns of various IBD medications in Switzerland before and during pregnancy over time. METHODS: A descriptive study using the MAMA cohort based on Swiss health insurance claims from 2012 to 2019. We identified pregnancies with a pharmaceutical cost group (PCG) indicating IBD and at least one dispensed IBD medication before pregnancy. We defined three groups based on dispensation timing: continuers (dispensation in pre-pregnancy and in or after trimester 2), switchers (different dispensation between pre-pregnancy and in or after trimester 2), and discontinuers (dispensation in pre-pregnancy but no dispensation in or after trimester 2). RESULTS: Among 84,317 deliveries, 0.4% had a PCG code for IBD with an IBD medication dispensed in pre-pregnancy. Half of these pregnancies were exposed to Aminosalicylates, with a consistent proportion over time. Pregnancies exposed to biologics seemed to increase over time, while immunosuppressant use remained steady. Roughly one-third with IBD medication before pregnancy discontinued treatment, a consistent rate throughout the study. CONCLUSIONS: Aminosalicylates were the most dispensed medication to treat IBD despite the lack of evidence to support their use as first-line therapy. The increase in biologics' dispensations likely reflects the growing evidence on the safety of these medications during pregnancy. One in three women discontinued all treatment during pregnancy, with a stable proportion over time. It is not known whether women discontinued treatment due to quiescent disease or concerns about medication harm. If the latter, these women should be identified and counseled, preferably during the pre-conception period, about the risks and benefits of disease and treatment.

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