EP196 - Pregnant patients with ostomies: Maternal and fetal outcomes

Purpose/Background: There are between 750,000 and 1 million people in the United States living with an ostomy, and 1 in 20,000 women with an ostomy become pregnant or give birth annually. Stoma related complications that may be experienced by pregnant patients include pouching issues, obstruction, prolapse, retraction, parastomal hernia, bleeding, and dehydration. The majority of literature about pregnant patients with ostomies comes from the 1980s to early 2000s. Newer studies remain limited to case reports, populations outside of the United States, small sample sizes, or include only the subgroup of patients with ostomies related to inflammatory bowel disease. The goal of this study was to measure how the presence of an ostomy in a pregnant patient impacts maternal and fetal outcomes.

Methods/Interventions: The 2016-2022 National Inpatient Sample database of inpatient hospital encounters in the United States was queried for female patients who had an ileostomy or colostomy and were pregnant using relevant ICD10 diagnosis codes. Patient demographics, co-morbidities, and outcomes were compared between pregnant patients with and without ostomies. Outcomes included maternal and fetal mortality and morbidity including hypertensive complications (pre-eclampsia, eclampsia, HELLP syndrome), post-partum hemorrhage, pre-term birth ( < 37 weeks), fetal growth restriction, and large fetus for gestational age.

Results/Outcomes: A weighted sample of over 26.7 million pregnant inpatient encounters was identified. Under 15,000 encounters also included an ostomy. The ostomy group was more likely to be older (31 years versus 29 years, p=0.000) and require longer length of stay (3 days versus 2 days, p=0.000). The ostomy group was more likely to suffer from complicated hypertension (2.3% versus 0.1%, p=0.000), preterm delivery (7.4% versus 4.0%, p=0.004), and fetal death (2.3% versus 0.8%, p=0.009). Of all patients with ostomies who experienced fetal death, none of them underwent intestinal surgery.

Conclusion/Discussion: Pregnant patients with ostomies have higher rates of complicated hypertension, preterm delivery, and fetal death. Pregnant ostomates are an important population that warrant further investigation to improve outcomes.

Demographics and outcomes of pregnant patients with and without ostomies.