Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

Smink, Marieke; Lotgering, F.K.; Albers, Lisette; Jong, Dirk J. de

doi:10.1186/1471-230x-11-6

Cited by 32 publications

(33 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast, Smink et al . from the Netherlands identified no increase in risk of progression to perianal involvement in CD patients without perianal disease prior to pregnancy for vaginal compared with CS delivery (5% vs. 14%, p=NS) 26 . We have recently described that vaginal delivery may be safe in women with perianal disease and not associated with short-term increase in risk of complications, albeit acknowledging a selection bias in women trialing a vaginal birth 35 .…”

Section: Discussionmentioning

confidence: 87%

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

et al. 2014

View full text Add to dashboard Cite

Introduction: Inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) often affect women in their reproductive years. Few studies have analyzed the impact of mode of child-birth 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 was used to estimate independent effect of mode of child-birth 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.

show abstract

Section: Discussionmentioning

confidence: 87%

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

et al. 2014

View full text Add to dashboard Cite

show abstract

“…However, few have examined the effect of mode of delivery on subsequent course of CD, particularly with reference to those with established perianal disease who represent a subgroup with potentially the greatest impact from this decision 13-17 . In this study from two large tertiary referral centers, we sought to address whether pregnancy or mode of delivery would affect likelihood of flare of perianal disease after pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The current practice is to pursue vaginal delivery if patients have quiescent disease, encourage Cesarean sections for patients with active perianal disease, and avoid episiotomies if possible. However, the literature in this field is largely limited 13-17 . Thus, there is an important unmet need for continued examination of the impact of mode of delivery on outcomes of patients with established perianal CD.…”

Section: Introductionmentioning

confidence: 99%

Impact of Mode of Delivery on Outcomes in Patients with Perianal Crohnʼs Disease

Cheng

Oxford

Sauk

et al. 2014

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Introduction Crohn's disease (CD) often affects women during the reproductive years. While several studies have examined the impact of pregnancy on luminal disease, limited literature exists in those with perianal CD. Decision regarding mode of delivery is a unique challenge in such patients due to concerns regarding the effect of pelvic floor trauma during delivery on pre-existing perianal involvement. Methods We performed a retrospective chart review of CD patients with established perianal disease undergoing either vaginal delivery or Caesarean section (C-section) at our institutions. We examined the occurrence of symptomatic perianal disease flares within 5 years after delivery in such women compared to non-pregnant CD controls. We also compared the occurrence of such flares between the two modes of delivery in women with established perianal CD. Results We identified 61 pregnant CD patients with established perianal disease (11 vaginal delivery, 50 via C-section) and 61 non-pregnant CD controls with perianal disease. One-third of the C-sections were primarily for obstetric indications. Six of the vaginal deliveries were complicated. Approximately 36% of cases had a symptomatic perianal flare within 1 year after delivery. This was similar across both modes of delivery (p=0.53), and similar to non-pregnant CD patients. There was no difference in the rates of perianal surgical intervention or luminal disease flares in our population based on mode of delivery, or between pregnant CD patients and non-pregnant CD controls. Conclusion We observed no difference in risk of symptomatic perianal flares in patients with established perianal CD delivering vaginally or via C-section.

show abstract

“…Episiotomy, if obstetrically possible to avoid, is not recommended for IBD patients due to risk of perianal complications; however, it is still preferred to uncontrolled obstetric perineal injury (7,20). Vaginal delivery in IBD patients is not associated with an increased risk of perianal disease compared to CS (7,22,23). The study presented in this paper did not show a statistically signifi cant difference in the incidence of obstetric perineal injury and the frequency of episiotomy across our study groups.…”

Section: Discussionmentioning

confidence: 61%

Risk of anal incontinence in women with inflammatory bowel diseases after delivery

Koželuhová¹,

J²,

Balihar³

et al. 2017

BLL

View full text Add to dashboard Cite

AIM: The aim of our prospective study was to evaluate the development of postpartum anal incontinence in patients with infl ammatory bowel disease (IBD) compared to healthy women. MATERIAL AND METHODS: Patients with IBD and healthy controls enrolled in the study from January 1st 2013 to November 30th 2016 and fi lled in the anal incontinence questionnaire in the beginning of pregnancy and after vaginal delivery. The results were statistically processed using suitable tests. RESULTS: A total of 57 women were enrolled, 17 (29.8 %) with ulcerative colitis, 23 (40.4 %) with Crohn's disease, and 17 (29.8 %) healthy controls. Incidence of postpartum anal incontinence is comparable across all groups; there was no statistically signifi cant difference between the IBD and control groups (Kruskal-Wallis test by ranks with Dunn correction, non-signifi cant). Postpartum anal incontinence was strongly correlated with the extent of perineal injury (r = 0.80; p < 0.0001; Pearson's linear correlation). CONCLUSIONS: Women with infl ammatory bowel disease in remission do not exhibit higher incidence of postpartum anal incontinence (PPAI) compared to healthy controls; the key correlate of PPAI appears to be the extent of obstetric injury, consistently across all study groups. These results suggest that concerns about postpartum anal incontinence development should not be an indication for Caesarean section in IBD patients (Tab. 6, Fig. 1, Ref. 34). Text in PDF www.elis.sk.

show abstract

Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

Cited by 32 publications

References 20 publications

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

Impact of Mode of Delivery on Outcomes in Patients with Perianal Crohnʼs Disease

Risk of anal incontinence in women with inflammatory bowel diseases after delivery

Contact Info

Product

Resources

About