M. Forry

Su1405 The Safety of Biologic Use in the Pregnant IBD Patient: Analysis of Patient Characteristics, Pregnancy and Neonatal Outcomes

Background: TNF alpha inhibitors are being increasingly used in IBD in women of fertile age. Studies to date have been mainly limited to case reports and case series with the largest observational cohort from 50 centres in the US. We aimed to prospectively assess the use of anti TNF treatment during pregnancy in a large European cohort. Methods: This was an observational cohort study addressing a 5 year period between 2008-2013. Female patients with IBD who had undergone anti-TNF treatment during pregnancy were identified using the IBD databases of 2 tertiary referral centres for IBD in Dublin. Patient characteristics including disease activity scores, duration, site and concomitant medications were recorded. Pregnancy outcomes including mode of delivery, miscarriage, ante and postnatal complications, age at conception and need for escalation of IBD treatment during pregnancy were also assessed. Neonatal outcomes including low birth weight, pre-term delivery, NICU stays or perinatal infection and timing of vaccines were also recorded. Data were analysed using t testing, contingency and logistic regression analyses. Results: From an IBD population of over 2,500 patients, 31 individual females who underwent anti -TNF treatment during pregnancy from 2008-2013 were identified with a total of 36 pregnancies. Median disease duration at time of pregnancy was 12 years (IQR 3-17). 85% had Crohns Disease, 15% Ulcerative Colitis. Median Harvey Bradshaw Index pre-pregnancy was 4.5 (IQR 2-13). Median Mayo score was 1 (IQR 0-3). 57.3% received infliximab, 38% adalimumab, 4.7% certolizimab. 53.8% were on concomitant immunemodulators. The majority of patients stopped biologic treatment at the start of the third trimester. 67% had treatment reinstated in the postpartum period. Median age at conception was 30.5 (IQR 25-35). 19% had previous miscarriages. 92% had successful term pregnancies. 22% required escalation of treatment during pregnancy. 19.3% had a pregnancy complication including emergency section. 16% neonates had a low birth weight with 2 preterm deliveries and one case of NICU stay for meconium ileus. No perinatal infections were reported. 20%mothers breastfed. The majority of mothers delayed live vaccination of their children. Interestingly, there was a significant independent association between disease activity at time of conception and low birthweight (p < 0.01). There was no association between adverse outcomes or neonatal infections and anti-TNF use noted in this cohort.Conclusion: Disease control at time of conception and through pregnancy should be the main goal of treatment in this patient cohort and the use of TNF alpha antagonists to achieve this appears to warranted to improve pregnancy outcomes though definitive safety has yet to be proven.

EXAMINATION OF THE EFFICACY OF A CHRONIC DISEASE SELF-MANAGEMENTRAMME (CDSMP) FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): A PILOT STUDY

Introduction The need for a psychosocial intervention for patients with IBD was recognised by multidisciplinary healthcare professionals working at a large Irish teaching hospital. CDSMP, developed by Stanford University, was identified as a leading model of psychosocial intervention. Run over 6 weeks in 2.5 hour weekly sessions and delivered by two people, one of whom must have a chronic illness, the CDSMP focuses on action planning and goal setting, using brainstorming exercises to help develop self management techniques. Aims/Background To pilot the use of a CDSMP in patients with IBD. Method A repeated measures design with wait list control (n=44) was utilised. Mood and general health related quality of life (HRQoL) were assessed using the Hospital Anxiety and Depression scale (HADS) and Rand 36-Item Health Survey (SF-36). The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was used to measure physical, social, and emotional status in patients with IBD. Qualitative descriptions of problems caused by chronic disease were noted the beginning and end of the six week intervention. Results 44 patients participated in the pilot study, 11 male (25%) and 33 female (75%). Significant improvement in mood was achieved in treatment group with paired sample t-tests indicated significant reduction in levels of depression on the HADS (p=0.05). At baseline, 14% of the treatment group displayed mild depression. Post-intervention no clinical levels of depression were evident in the treatment group compared to 17% of waitlist control who displayed mild to severe levels of depression. Significant improvement was noted in the SF-36 on the factor of emotional well-being (p=0.04). There was also an improvement in the qualitative descriptions of problems related to chronic disease. Of note, 14% of the treatment group were experiencing relapses in their condition at the end of the CDSMP. Conclusion The results of this study indicate that CDSMP appears to be an effective psychosocial intervention for patients with IBD. Implementation of a CDSMP in hospital and community settings in Ireland for this patient group should be considered.

Su1248 Quality of Life in Inflammatory Bowel Disease: What Does the Short Health Scale Actually Measure?

P162 Quality of life in inflammatory bowel disease: What does the Short Health Scale actually measure? E. McDermott1 *, V. Kale1, N. Rafter1, D. Keegan1, K. Byrne1, M. Forry2, G. Doherty1, G. Cullen1, K. Malone3, S. Patchett2, H. Mulcahy1. 1St Vincent’s University Hospital, Centre for Colorectal Disease, Dublin, Ireland, 2Beaumont Hospital, Department of Gastroenterology, Dublin, Ireland, 3St Vincent’s University Hospital, Department of Psychiatry, Dublin, Ireland