Shedding Light on Pancreatitis in Pregnancy

A recent study by DFM Associate Professor Jennifer Eddy, MD, and Assistant Professor Mark Gideonsen, MD, has provided an up-to-date, comprehensive characterization of pancreatitis in pregnancy, a rare condition that occurs in approximately one in 3,000 pregnancies.

Over the past three decades, little definitive information has been published in the medical literature on the incidence, causes, complications, and management of the condition.

The study, "Pancreatitis in Pregnancy," published in the November 2008 issue of Obstetrics and Gynecology (the "Green Journal") aimed to change that. The largest of its kind, the study reviewed 101 cases of pancreatitis in pregnancy from 1992 to 2001 at 15 Midwest hospitals.

Specifically, Eddy and Gideonsen's research found the following:

• Of the 101 women who had pancreatitis during pregnancy, 89 had acute pancreatitis and 12 had chronic pancreatitis.
• Of 89 acute pancreatitis cases, 66% were caused by gallstones, 17% were idiopathic, and 12% were caused by alcohol abuse.
• Of 12 chronic pancreatitis cases, 58% were caused by alcohol and 25% were idiopathic.
• Acute gallstone pancreatitis was associated with better outcomes than nonbiliary pancreatitis.
• Surgical or endoscopic intervention for gallstone pancreatitis was associated with lower rates of recurrence and preterm delivery, but not significantly so.
• Alcohol-related pancreatitis was associated with increased rates of recurrence and preterm delivery.
• A calcium level and/or triglycerides were not obtained in half of the idiopathic cases.

Generalizable Data Helps Improve Care

Dr. Eddy's motivation for this study goes back nearly 10 years, to a pregnant patient who not only had pancreatitis but a pancreatic pseudocyst.

While researching how to best care for her patient, Dr. Eddy found that the literature on pancreatitis in pregnancy was sparse, outdated, or highly focused on a single institution, country, or subset of cases.

"I wanted to characterize pancreatitis in pregnancy more broadly," she said. "Because this is a bigger study and includes a cross-section of institutions, clinicians can generalize from it more accurately."

Dr. Eddy hopes that the study's results will help inform clinicians' decision making when they encounter that rare pregnant woman with pancreatitis.

"This study not only highlights pancreatitis as a possible issue in pregnancy, but also shows that it is not always caused by gallstones, as it is sometimes assumed to be. Since other causes are associated with worse outcomes, it is important to check calcium and triglyceride levels in these women."

"We also should make sure our pregnant patients are not using alcohol," Dr. Gideonsen added. "We know that checking these key elements will help improve quality of care."

Dr. Eddy's research was supported by a Department of Family Medicine Small Grant.