Abstract
BackgroundPregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and especially perianal Crohn's disease.MethodsThis is a retrospective cohort study which was performed in a tertiary level referral hospital in the Netherlands. From the IBD database, female patients aged 18-80 years in 2004 were selected. Data analysis took place in the years 2005 and 2006. Eventually, 114 women with at least one pregnancy after the diagnosis of Crohn's disease were eligible for the study. Differences between groups were analyzed using Wilcoxon Mann Whitney tests and Chi-square analysis with 2 × 2 or 2 × 3 contingency tables. Two-tailed values were used and p values < 0.05 were considered statistically significant.Results21/114 women (18%) had active luminal disease prior to pregnancy, with significantly more pregnancy related complications compared to women with inactive luminal disease (Odds ratio 2.8; 95% CI 1.0 - 7.4). Caesarean section rate was relatively high (37/114, 32%), especially in patients with perianal disease prior to pregnancy compared to women without perianal disease (Odds ratio 4.6; 95% CI 1.8 - 11.4). Disease progression after childbirth was more frequent in patients with active luminal disease prior to pregnancy compared to inactive luminal disease (Odds ratio 9.7; 95% CI 2.1 - 44.3). Progression of perianal disease seems less frequent after vaginal delivery compared with caesarean section, in both women with prior perianal disease (18% vs. 31%, NS) and without prior perianal disease (5% vs 14%, NS). There were no more fistula-related complications after childbirth in women with an episiotomy or second degree tear.ConclusionA relatively high rate of caesarean sections was observed in women with Crohn's disease, especially in women with perianal disease prior to pregnancy. A protective effect of caesarean section on progression of perianal disease was not observed. However, this must be interpreted carefully due to confounder effect by indication for caesarean section.
Highlights
Pregnant women with Crohn’s disease needs proper counselling about the effect of pregnancy and childbirth on their disease
A protective effect of caesarean section on progression of perianal disease was not observed. This must be interpreted carefully due to confounder effect by indication for caesarean section
In women with active perianal disease, a caesarean section is recommended by the guideline
Summary
Pregnant women with Crohn’s disease needs proper counselling about the effect of pregnancy and childbirth on their disease. Literature about the effect of childbirth on Crohn’s disease is limited. This study examined the effect of childbirth on the course of Crohn’s disease and especially perianal Crohn’s disease. The effects of pregnancy on Crohn’s disease and vice versa have been studied and directions for counselling have been formulated [2,3,4,5,6,7]. The literature, is limited about the effects of the mode of childbirth on the course of Crohn’s disease especially in those women whose Crohn’s disease is complicated by perianal disease [8]. The guideline concerning pregnancy and Crohn’s disease recommends vaginal delivery for women with quiescent or mild disease [1]. The advice in the guideline that concerns the mode of childbirth is based on two small studies only [8,9]
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