Risk of Postpartum Flare Hospitalizations in Patients with Inflammatory Bowel Disease Persists After Six Months

Background: Although patients with IBD are at higher risk for flares during the postpartum period, little is known about the risk factors, timeline, and healthcare-associated costs of a readmission flare. Aims: To ascertain the timeline in which patients are hospitalized for postpartum inflammatory bowel disease (IBD) flares, and the associated risk factors. Methods: This is a nationwide retrospective cohort study of 7054 patients with IBD who delivered between 2010–2014 obtained from the National Readmissions Database. The presence of IBD was defined using previously validated International Classification of Diseases codes, and univariable and multivariable regression models were performed to assess risk factors associated with a postpartum flare hospitalization over the nine-month observation period. Results: A total of 353 (5.0%) patients were hospitalized for a postpartum IBD flare, with approximately one-third (30.0%) readmitted after 6 months. On multivariable analysis, having Crohn’s disease (aRR 1.47, 95%CI 1.16–1.88), Medicare insurance (aRR 3.30, 95%CI 2.16–5.02), and ≥ 2 comorbidities (aRR 1.34, 95%CI 1.03–1.74) were independently associated with a higher risk of an IBD flare hospitalization. Compared to patients aged 25–29, those 20–24 were at higher risk for an IBD flare readmission (aRR 1.58, 95%CI 1.17–2.13), whereas patients aged 35–39 years were at lower risk (aRR 0.63, 95%CI 0.43–0.92). Conclusions: Among patients with IBD, Crohn’s disease, Medicare insurance, multiple comorbidities, and younger age were independent risk factors for a postpartum IBD flare hospitalization. As approximately one-third of these readmissions occurred after 6 months, it is imperative to ensure adequate follow-up and treatment for postpartum IBD patients, particularly in the extended postpartum period.