Elevated interferon-gamma levels during pregnancy are associated with adverse maternofetal outcomes in IBD

We read with interest van der Giessen’s observations of pregnancy-associated fluctuations in peripheral blood cytokines and stool microbiota in the setting of IBD.1 In this study, the authors profiled preconception and pregnancy-associated cytokine levels and demonstrated a significant decrease in proinflammatory cytokines (interleukin (IL)-6, IL-8, IL-12, IL-17 and tumour necrosis factor-α) during pregnancy in women with IBD. We had undertaken a similar cytokine analysis of pregnant women with IBD at the University of Calgary but sought to relate preconception and second-trimester cytokine levels with adverse maternal–fetal outcomes, including preterm birth, emergency caesarean delivery and neonatal intensive care unit (NICU) admission. Sera from 28 women with IBD, including 19 with Crohn’s disease (CD) and 9 with UC who completed a pregnancy between 2013 and 2015, were analysed. Eighteen of these patients were on biological therapy preconception (infliximab n (CD)=7, n (UC)=4; adalimumab n (CD)=7). Disease activity was prospectively evaluated using validated disease activity indices, physician global assessment and C-reactive protein. Faecal calprotectin results were not available. Only one patient (with CD) had active disease at the time of preconception blood sampling, while three women (1 with …