Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases


Ananthakrishnan AN, Cheng A, Cagan A, Cai T, Gainer VS, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, et al. Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases. Dig Dis Sci. 2015;60 :471-7.

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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.


Ananthakrishnan, Ashwin NCheng, AliceCagan, AndrewCai, TianxiGainer, Vivian SShaw, Stanley YChurchill, SusanneKarlson, Elizabeth WMurphy, Shawn NKohane, IsaacLiao, Katherine PengK08 AR060257/AR/NIAMS NIH HHS/K23 DK097142/DK/NIDDK NIH HHS/K24 AR052403/AR/NIAMS NIH HHS/P60 AR047782/AR/NIAMS NIH HHS/R01 AR049880/AR/NIAMS NIH HHS/U54 LM008748/LM/NLM NIH HHS/U54-LM008748/LM/NLM NIH HHS/Comparative StudyMulticenter StudyResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov't2014/09/13 06:00Dig Dis Sci. 2015 Feb;60(2):471-7. doi: 10.1007/s10620-014-3353-6. Epub 2014 Sep 12.