ヨネザワ　マリア   YONEZAWA Maria   米澤　麻利亜    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes.
掲載誌名	正式名：Digestive diseases and sciences 略　 称：Dig Dis Sci ISSNコード：15732568/01632116
掲載区分	国外
巻・号・頁	66(2),pp.577-586
著者・共著者	Watanabe Chikako, Nagahori Masakazu, Fujii Toshimitsu, Yokoyama Kaoru, Yoshimura Naoki, Kobayashi Taku, Yamagami Hirokazu, Kitamura Kazuya, Takashi Kagaya, Nakamura Shiro, Naganuma Makoto, Ishihara Shunji, Esaki Motohiro, Yonezawa Maria, Kunisaki Reiko, Sakuraba Atsushi, Kuji Naoaki, Miura Soichiro, Hibi Toshifumi, Suzuki Yasuo, Hokari Ryota
発行年月	2021/02
概要	BACKGROUND:Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference.METHODS:Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes.RESULTS:Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians' estimate (p = 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928-30.427, p = 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350-51.994, p = 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse (p = 0.002).CONCLUSION:Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted.
DOI	10.1007/s10620-020-06221-6
PMID	32249373