Abstract
Introduction
Inflammatory bowel diseases [IBD; Crohn’s disease (CD), ulcerative colitis] often affect women in their reproductive years. Few studies have analyzed the impact of mode of childbirth on long-term IBD outcomes.
Methods
We used a multi-institutional IBD cohort to identify all women in the reproductive age-group with a diagnosis of IBD prior to pregnancy. We identified the occurrence of a new diagnosis code for perianal complications, IBD-related hospitalization and surgery, and initiation of medical therapy after either a vaginal delivery or caesarean section (CS). Cox proportional hazards models adjusting for potential confounders were used to estimate independent effect of mode of childbirth on IBD outcomes.
Results
Our cohort included 360 women with IBD (161 CS). Women in the CS group were likely to be older and more likely to have complicated disease behavior prior to pregnancy. During follow-up, there was no difference in the likelihood of IBD-related surgery (multivariate hazard ratio 1.75, 95 % confidence interval (CI) 0.40–7.75), IBD-related hospitalization (HR 1.39), initiation of immunomodulator therapy (HR 1.45), or anti-TNF therapy (HR 1.11). Among the 133 CD pregnancies with no prior perianal disease, we found no excess risk of subsequent new diagnosis perianal fistulae with vaginal delivery compared to CS (HR 0.19, 95 % CI 0.04–1.05).
Conclusions
Mode of delivery did not influence natural history of IBD. In our cohort, vaginal delivery was not associated with increased risk of subsequent perianal disease in women with CD.
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References
Cosnes J, Gower-Rousseau C, Seksik P, et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–1794.
Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am. 2002;31:1–20.
Mountifield RE, Prosser R, Bampton P, et al. Pregnancy and IBD treatment: this challenging interplay from a patients’ perspective. J Crohns Colitis. 2010;4:176–182.
Selinger CP, Eaden J, Selby W, et al. Patients’ knowledge of pregnancy-related issues in inflammatory bowel disease and validation of a novel assessment tool (‘CCPKnow’). Aliment Pharmacol Ther. 2012;36:57–63.
Selinger CP, Eaden J, Selby W, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis. 2013;7:e206–e213.
Agret F, Cosnes J, Hassani Z, et al. Impact of pregnancy on the clinical activity of Crohn’s disease. Aliment Pharmacol Ther. 2005;21:509–513.
Ferrero S, Ragni N. Inflammatory bowel disease: management issues during pregnancy. Arch Gynecol Obstet. 2004;270:79–85.
Friedman S, Regueiro MD. Pregnancy and nursing in inflammatory bowel disease. Gastroenterol Clin North Am. 2002;31:265–273, xii.
Kornfeld D, Cnattingius S, Ekbom A. Pregnancy outcomes in women with inflammatory bowel disease—a population-based cohort study. Am J Obstet Gynecol. 1997;177:942–946.
Mahadevan U, Cucchiara S, Hyams JS, et al. The London position statement of the world congress of gastroenterology on biological therapy for IBD with the European Crohn’s and colitis organisation: pregnancy and pediatrics. Am J Gastroenterol. 2011;106:214–223; quiz 224.
Ng SW, Mahadevan U. Management of inflammatory bowel disease in pregnancy. Expert Rev Clin Immunol. 2013;9:161–173; quiz 174.
Rogers RG, Katz VL. Course of Crohn’s disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol. 1995;12:262–264.
Huang VW, Habal FM. From conception to delivery: managing the pregnant inflammatory bowel disease patient. World J Gastroenterol. 2014;20:3495–3506.
Mahadevan U, Sandborn WJ, Li DK, et al. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007;133:1106–1112.
Selinger CP, Leong RW, Lal S. Pregnancy related issues in inflammatory bowel disease: evidence base and patients’ perspective. World J Gastroenterol. 2012;18:2600–2608.
Gisbert JP, Chaparro M. Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol. 2013;108:1426–1438.
Hutson JR, Matlow JN, Moretti ME, et al. The fetal safety of thiopurines for the treatment of inflammatory bowel disease in pregnancy. J Obstet Gynaecol. 2013;33:1–8.
Saha S, Wald A. Safety and efficacy of immunomodulators and biologics during pregnancy and lactation for the treatment of inflammatory bowel disease. Expert Opin Drug Saf. 2012;11:947–957.
Allen VM, Baskett TF, O’Connell CM. Contribution of select maternal groups to temporal trends in rates of caesarean section. J Obstet Gynaecol Can. 2010;32:633–641.
Fairley L, Dundas R, Leyland AH. The influence of both individual and area based socioeconomic status on temporal trends in Caesarean sections in Scotland 1980–2000. BMC Public Health. 2011;11:330.
Roberts CL, Algert CS, Carnegie M, et al. Operative delivery during labour: trends and predictive factors. Paediatr Perinat Epidemiol. 2002;16:115–123.
Manosa M, Navarro-Llavat M, Marin L, et al. Fecundity, pregnancy outcomes, and breastfeeding in patients with inflammatory bowel disease: a large cohort survey. Scand J Gastroenterol. 2013;48:427–432.
Cornish J, Tan E, Teare J, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007;56:830–837.
Hatch Q, Champagne BJ, Maykel JA, et al. Crohn’s disease and pregnancy: the impact of perianal disease on delivery methods and complications. Dis Colon Rectum. 2014;57:174–178.
Ilnyckyji A, Blanchard JF, Rawsthorne P, et al. Perianal Crohn’s disease and pregnancy: role of the mode of delivery. Am J Gastroenterol. 1999;94:3274–3278.
Smink M, Lotgering FK, Albers L, et al. Effect of childbirth on the course of Crohn’s disease; results from a retrospective cohort study in the Netherlands. BMC Gastroenterol. 2011;11:6.
Brandt LJ, Estabrook SG, Reinus JF. Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn’s disease. Am J Gastroenterol. 1995;90:1918–1922.
Ananthakrishnan AN, Cagan A, Gainer VS, et al. Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn’s disease. Inflamm Bowel Dis. 2013;19:1921–1927.
Ananthakrishnan AN, Cagan A, Gainer VS, et al. Mortality and extraintestinal cancers in patients with primary sclerosing cholangitis and inflammatory bowel disease. J Crohns Colitis. 2014;8:956–963.
Ananthakrishnan AN, Cai T, Savova G, et al. Improving case definition of Crohn’s disease and ulcerative colitis in electronic medical records using natural language processing: a novel informatics approach. Inflamm Bowel Dis. 2013;19:1411–1420.
Ananthakrishnan AN, Cheng SC, Cai T, et al. Serum inflammatory markers and risk of colorectal cancer in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12:1342–1348.
Ananthakrishnan AN, Cheng SC, Cai T, et al. Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12:821–827.
Ananthakrishnan AN, Gainer VS, Perez RG, et al. Psychiatric co-morbidity is associated with increased risk of surgery in Crohn’s disease. Aliment Pharmacol Ther. 2013;37:445–454.
Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–2589.
Cheng AG, Oxford EC, Sauk J, et al. The impact of mode of delivery on outcomes in patients with perianal Crohn’s disease. Inflamm Bowel Dis. 2014;20:1391–1398.
Acknowledgments
The study was supported by NIH U54-LM008748. A.N.A is supported by funding from the American Gastroenterological Association and from the US National Institutes of Health (K23 DK097142). K.P.L. is supported by NIH K08 AR060257 and the Harold and Duval Bowen Fund. E.W.K is supported by grants from the NIH (K24 AR052403, P60 AR047782, R01 AR049880).
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Ananthakrishnan, A.N., Cheng, A., Cagan, A. et al. Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases. Dig Dis Sci 60, 471–477 (2015). https://doi.org/10.1007/s10620-014-3353-6
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DOI: https://doi.org/10.1007/s10620-014-3353-6