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Pregnancy and Delivery Before and After Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease: Immediate and Long-Term Consequences and Outcomes

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  • Published:
Diseases of the Colon & Rectum

PURPOSE:

This study was designed to evaluate pregnancy, delivery, and functional outcome in females before and after ileal pouch-anal anastomosis for chronic ulcerative colitis.

METHODS:

From a prospective database of 1,454 patients who underwent ileal pouch-anal anastomosis for chronic ulcerative colitis between 1981 and 1995, a standardized questionnaire was sent to all female patients aged 40 years or younger at the time of ileal pouch-anal anastomosis (n = 544).

RESULTS:

The response rate was 83 percent (450/544) with a mean follow-up after ileal pouch-anal anastomosis of 13 years. A total of 141 females were pregnant after the chronic ulcerative colitis diagnosis, but before ileal pouch-anal anastomosis (236 pregnancies; mean, 1.7) and 87 percent delivered vaginally. A mean of five (range, 1–16) years after ileal pouch-anal anastomosis, 135 females were pregnant (232 pregnancies; mean, 1.7). Comparison of pregnancy and delivery before and after ileal pouch-anal anastomosis in the same females (n = 37) showed no difference in birth weight, duration of labor, pregnancy/delivery complications, vaginal delivery rates (59 percent before vs. 54 percent after ileal pouch-anal anastomosis), and unplanned cesarean section (19 vs.14 percent). Planned cesareans occurred only after ileal pouch-anal anastomosis and were prompted by obstetrical concerns in only one of eight. Pouch function at first follow-up after delivery (mean, 7 months) was similar to pregravida function. After ileal pouch-anal anastomosis, daytime stool frequency was the same after delivery as pregravida (5.4 vs. 5.4, not significant) but was increased at the time of last follow-up (68 months after delivery; 5.4 vs. 6.4; P < 0.001). The rate of occasional fecal incontinence also was higher (20 percent after ileal pouch-anal anastomosis and 21 percent pregravida vs. 36 percent at last follow-up; P = 0.01). No difference in functional outcome was noted compared with females who were never pregnant after ileal pouch-anal anastomosis (n = 307). Age and becoming pregnant did not affect the probability of pouch-related complications, such as stricture, pouchitis, and obstruction.

CONCLUSIONS:

Successful pregnancy and vaginal delivery occur routinely in females with chronic ulcerative colitis before and after ileal pouch-anal anastomosis. The method of delivery should be dictated by obstetrical considerations. Pouch function and the incidence of complications in females with pregnancies seem largely unaffected long-term.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

    Dieter Hahnloser M.D., John H. Pemberton M.D., Bruce G. Wolff M.D., Dirk Larson M.S., Jeffrey Harrington M.S., Ridzuan Farouk M.D. & Roger R. Dozois M.D.

  2. Division of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland

    Dieter Hahnloser M.D.

Authors
  1. Dieter Hahnloser M.D.
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  2. John H. Pemberton M.D.
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  3. Bruce G. Wolff M.D.
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  4. Dirk Larson M.S.
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  5. Jeffrey Harrington M.S.
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  6. Ridzuan Farouk M.D.
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  7. Roger R. Dozois M.D.
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Correspondence to John H. Pemberton M.D..

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Hahnloser, D., Pemberton, J., Wolff, B. et al. Pregnancy and Delivery Before and After Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease: Immediate and Long-Term Consequences and Outcomes. Dis Colon Rectum 47, 1127–1135 (2004). https://doi.org/10.1007/s10350-004-0569-0

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  • DOI: https://doi.org/10.1007/s10350-004-0569-0

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