Skip to main content

Advertisement

SpringerLink
Log in

Major Variation in the Incidence of Appendicitis Before, During and After Pregnancy: A Population-Based Cohort Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Previous studies indicate a low incidence of appendicitis in third-trimester pregnancy, suggesting a protecting effect of pregnancy. This large population-based cohort study analyzes the association of appendicitis with pregnancy in more detail. The aim of the study was to investigate the incidence of appendicitis and negative appendectomy before, during and after pregnancy.

Methods

Cross-linking between two Swedish health registries provided data on appendectomy for all women in Sweden giving birth between 1973 and 2013. We analyzed the incidence rates (IR) of perforated and non-perforated appendicitis and negative appendectomy before, during and after pregnancy, and secular trends during the study period. Standardized incidence ratios (SIR) were estimated using age-, sex- and period-specific IR from the background population in Sweden.

Results

Some 3,888,452 pregnancies resulted in birth during the study period. An appendectomy was registered for 27,575 women in the interval starting one year before and ending two years after pregnancy. The incidence of appendicitis varied substantially during and after pregnancy. SIR for perforated appendicitis was 0.47 (95% CI 0.38–0.59) in the third trimester, 3.89 (2.92–5.18) peripartum, 2.20 (1.89–2.55) in the puerperium and 1.27 (1.19–1.36) in the year postpartum. The pattern was similar for non-perforated appendicitis. Negative appendectomy decreased postpartum. Incidence rate of non-perforated appendicitis and negative appendectomy decreased for both pregnant and non-pregnant women during the study period.

Conclusions

The findings in this study suggest a protecting effect of pregnancy on the development of appendicitis, which is followed by a rebound effect after birth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Augustin G, Majerovic M (2007) Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 131(1):4–12

    PubMed  Google Scholar 

  2. Bouyou J, Gaujoux S, Marcellin L et al (2015) Abdominal emergencies during pregnancy. J Visc Surg. https://doi.org/10.1016/j.jviscsurg.2015.09.017

    Article  PubMed  Google Scholar 

  3. Al-Mulhim AA (1996) Acute appendicitis in pregnancy. A review of 52 cases. Int Surg 81(3):295–297

    CAS  PubMed  Google Scholar 

  4. Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78(9):758–762

    CAS  PubMed  Google Scholar 

  5. Mourad J, Elliott JP, Erickson L et al (2000) Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 182(5):1027–1029

    CAS  PubMed  Google Scholar 

  6. Tracey M, Fletcher HS (2000) Appendicitis in pregnancy. Am Surg 66(6):555–559 (discussion 559-560)

    CAS  PubMed  Google Scholar 

  7. Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77(6):835–840

    CAS  PubMed  Google Scholar 

  8. Andersson RE, Lambe M (2001) Incidence of appendicitis during pregnancy. Int J Epidemiol 30(6):1281–1285

    CAS  PubMed  Google Scholar 

  9. Zingone F, Sultan AA, Humes DJ et al (2015) Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg 261(2):332–337

    PubMed  Google Scholar 

  10. Miloudi N, Brahem M, Ben Abid S et al (2012) Acute appendicitis in pregnancy: specific features of diagnosis and treatment. J Visc Surg 149(4):e275–e279

    CAS  PubMed  Google Scholar 

  11. Tamir IL, Bongard FS, Klein SR (1990) Acute appendicitis in the pregnant patient. Am J Surg 160(6):571–575 (discussion 5-6)

    CAS  PubMed  Google Scholar 

  12. Arnbjornsson E (1984) The influence of oral contraceptives on the frequency of acute appendicitis in different phases of the menstrual cycle. Surg Gynecol Obstet 158(5):464–466

    CAS  PubMed  Google Scholar 

  13. Evgenikos N, McLaren J, Macleod DA (2000) Menstruation, the oral contraceptive pill, and acute appendicitis. Eur J Surg 166(8):638–641

    CAS  PubMed  Google Scholar 

  14. Arnbjornsson E (1983) Acute appendicitis risk in various phases of the menstrual cycle. Acta Chir Scand 149(6):603–605

    CAS  PubMed  Google Scholar 

  15. Ernerudh J, Berg G, Mjosberg J (2011) Regulatory T helper cells in pregnancy and their roles in systemic versus local immune tolerance. Am J Reprod Immunol 66(Suppl 1):31–43

    PubMed  Google Scholar 

  16. Lima J, Martins C, Nunes G et al (2017) Regulatory T cells show dynamic behavior during late pregnancy, delivery, and the postpartum period. Reprod Sci 24(7):1025–1032

    CAS  PubMed  Google Scholar 

  17. Graham C, Chooniedass R, Stefura WP et al (2017) In vivo immune signatures of healthy human pregnancy: inherently inflammatory or anti-inflammatory? PloS one 12(6):e0177813

    PubMed  PubMed Central  Google Scholar 

  18. Saito S, Sakai M, Sasaki Y et al (1999) Quantitative analysis of peripheral blood Th0, Th1, Th2 and the Th1:Th2 cell ratio during normal human pregnancy and preeclampsia. Clin Exp Immunol 117(3):550–555

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Hosseini A, Dolati S, Hashemi V et al (2018) Regulatory T and T helper 17 cells: their roles in preeclampsia. J Cell Physiol 233(9):6561–6573

    CAS  PubMed  Google Scholar 

  20. Sykes L, MacIntyre DA, Yap XJ et al (2012) The Th1: Th2 dichotomy of pregnancy and preterm labour. Mediat Inflamm 2012:967629

    Google Scholar 

  21. Gold SM, Voskuhl RR (2016) Pregnancy and multiple sclerosis: from molecular mechanisms to clinical application. Semin Immunopathol 38(6):709–718

    CAS  PubMed  Google Scholar 

  22. Marder W, Littlejohn EA, Somers EC (2016) Pregnancy and autoimmune connective tissue diseases. Best Pract Res Clin Rheumatol 30(1):63–80

    PubMed  PubMed Central  Google Scholar 

  23. Hashash JG, Kane S (2015) pregnancy and inflammatory bowel disease. Gastroenterol Hepatol 11(2):96–102

    Google Scholar 

  24. Jethwa H, Lam S, Smith C et al (2018) Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol 46(3):245–250

    PubMed  Google Scholar 

  25. Dunsmore G, Koleva P, Ghobakhloo N et al (2018) Lower abundance and impaired function of CD71+ erythroid cells in inflammatory bowel disease patients during pregnancy. J Crohn’s Colitis 13(2):230–244

    Google Scholar 

  26. Hughes SE, Spelman T, Gray OM et al (2014) Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 20(6):739–746

    PubMed  Google Scholar 

  27. Nuriel-Ohayon M, Neuman H, Koren O (2016) Microbial changes during pregnancy, birth, and infancy. Front Microbiol 7:1031

    PubMed  PubMed Central  Google Scholar 

  28. Koren O, Goodrich JK, Cullender TC et al (2012) Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell 150(3):470–480

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Brann E, Edvinsson A, Rostedt Punga A et al (2019) Inflammatory and anti-inflammatory markers in plasma: from late pregnancy to early postpartum. Sci Rep 9(1):1863

    PubMed  PubMed Central  Google Scholar 

  30. Lazarus E, Debenedectis C, North D et al (2009) Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients—1997–2006. Radiology 251(2):517–524

    PubMed  Google Scholar 

  31. Andersson RE (2015) Confusing diagnosis coding prevents historical and international comparisons. Diagnosing should be unambiguous and consistent. Lakartidningen, p 112

  32. Ludvigsson JF, Andersson E, Ekbom A et al (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450

    PubMed  PubMed Central  Google Scholar 

  33. http://www.socialstyrelsen.se/lists/artikelkatalog/attachments/10961/2002-112-4_20021124.pdf. (Swedish only). Accessed 18 Jan 2020

Download references

Funding

This work was supported by Futurum - Academy of Healthcare at Region Jönköping County. There was no involvement of the funder in study design, data collection, data analysis, manuscript preparation and publication decisions, and we confirm that we had complete access to the study data that support the publication.

Author information

Authors and Affiliations

  1. Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden

    E. Moltubak, K. Landerholm & R. E. Andersson

  2. Department of Clinical and Experimental Medicine, Faculty of Medicine, Health Sciences Linköping University, Linköping, Sweden

    E. Moltubak, K. Landerholm & R. E. Andersson

  3. Division of Children’s and Women’s Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Health Sciences Linköping University, 581 85, Linköping, Sweden

    M. Blomberg

  4. Department of Surgery, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, 581 85, Linköping, Sweden

    S. Redéen

Authors
  1. E. Moltubak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Landerholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Blomberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Redéen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. E. Andersson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Moltubak.

Ethics declarations

Conflict of interest

We declare no conflicts of interest.

Ethical approval

The study was approved by the Regional Ethical Review Board at Linköping University, Linköping, Sweden (dnr 2014/338-31 and 2015/364-32).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moltubak, E., Landerholm, K., Blomberg, M. et al. Major Variation in the Incidence of Appendicitis Before, During and After Pregnancy: A Population-Based Cohort Study. World J Surg 44, 2601–2608 (2020). https://doi.org/10.1007/s00268-020-05524-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05524-z

Search

Navigation