The mode of delivery does not influence the occurrence of post-partum perianal disease flares in patients with inflammatory bowel disease.
Cesarean section
Inflammatory bowel Disease
Perianal Disease
Vaginal delivery
Journal
BMC gastroenterology
ISSN: 1471-230X
Titre abrégé: BMC Gastroenterol
Pays: England
ID NLM: 100968547
Informations de publication
Date de publication:
16 Jan 2024
16 Jan 2024
Historique:
received:
18
06
2023
accepted:
28
10
2023
medline:
17
1
2024
pubmed:
17
1
2024
entrez:
16
1
2024
Statut:
epublish
Résumé
Perianal disease occurs in up to 34% of inflammatory bowel disease (IBD) patients. An estimated 25% of women will become pregnant after the initial diagnosis, thus introducing the dilemma of whether mode of delivery affects perianal disease. The aim of our study was to analyze whether a cesarean section (C-section) or vaginal delivery influence perianal involvement. We hypothesized the delivery route would not alter post-partum perianal manifestations in the setting of previously healed perianal disease. All consecutive eligible IBD female patients between 1997 and 2022 who delivered were included. Prior perianal involvement, perianal flare after delivery and delivery method were noted. We identified 190 patients with IBD who had a total of 322 deliveries; 169 (52%) were vaginal and 153 (48%) were by C-section. Nineteen women (10%) experienced 21/322 (6%) post-partum perianal flares. Independent predictors were previous abdominal surgery for IBD (OR, 2.7; 95% CI, 1-7.2; p = 0.042), ileocolonic involvement (OR, 3.3; 95% CI, 1.1-9.4; p = 0.030), previous perianal disease (OR, 22; 95% CI, 7-69; p < 0.001), active perianal disease (OR, 96; 95% CI, 21-446; p < 0.001) and biologic (OR, 4.4; 95% CI,1.4-13.6; p < 0.011) or antibiotic (OR, 19.6; 95% CI, 7-54; p < 0.001) treatment. Negative association was found for vaginal delivery (OR, 0.19; 95% CI, 0.06-0.61; p < 0.005). Number of post-partum flares was higher in the C-section group [17 (11%) vs. 4 (2%), p = 0.002]. Delivery by C-section section was not protective of ongoing perianal disease activity post-delivery, but should be recommended for women with active perianal involvement.
Identifiants
pubmed: 38229023
doi: 10.1186/s12876-023-03018-5
pii: 10.1186/s12876-023-03018-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
34Informations de copyright
© 2024. The Author(s).
Références
Brandt LJ, Estabrook SGRJ. Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn’s Disease. Am J Gastroenterol. 1995;90:1918–22.
pubmed: 7484992
Ilnyckyj A, Blanchard JF, Rawsthorne P, Bernstein CN. Perianal Crohn’s Disease and pregnancy: role of the mode of delivery. Am J Gastroenterol. 1999;94(11):3274–8.
doi: 10.1111/j.1572-0241.1999.01537.x
Rogers RG, Katz VL. Course of Crohn’s Disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol. 1995;12(4):262–4.
doi: 10.1055/s-2007-994469
pubmed: 7575831
Brochard C, Rabilloud ML, Hamonic S, Bajeux E, Pagenault M, Dabadie A, et al. Natural history of Perianal Crohn’s Disease: long-term follow-up of a Population-based cohort. Clin Gastroenterol Hepatol. 2022;20(2):e102–10.
doi: 10.1016/j.cgh.2020.12.024
pubmed: 33359730
Schaden D, Schauer G, Haas F, Berger A. Myocutaneous flaps and proctocolectomy in severe perianal Crohn’s disease–a single stage procedure. Int J Colorectal Dis. 2007;22(12):1453–7.
doi: 10.1007/s00384-007-0337-4
pubmed: 17583818
Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, et al. European evidence based consensus on the diagnosis and management of Crohn’s Disease: special situations. Gut. 2006;55(Suppl 1):Suppl1.
Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, et al. A meta-analysis on the influence of inflammatory bowel Disease on pregnancy. Gut. 2007;56(6):830–7.
doi: 10.1136/gut.2006.108324
pubmed: 17185356
Dominitz JA, Young JCC, Boyko EJ. Outcomes of infants born to mothers with inflammatory bowel Disease: a population-based cohort study. Am J Gastroenterol. 2002;97(3):641–8.
doi: 10.1111/j.1572-0241.2002.05543.x
pubmed: 11926208
Moser MAJ, Okun NB, Mayes DC, Bailey RJ. Crohn’s Disease, pregnancy, and birth weight. Am J Gastroenterol. 2000;95(4):1021–6.
doi: 10.1111/j.1572-0241.2000.01852.x
pubmed: 10763954
PORTER RJ, STIRRAT GM. The effects of inflammatory bowel Disease on pregnancy: a case-controlled retrospective analysis. Br J Obstet Gynaecol. 1986;93(11):1124–31.
doi: 10.1111/j.1471-0528.1986.tb08632.x
pubmed: 3778845
Borello-France D, Burgio KL, Richter HE, Zyczynski H, FitzGerald MP, Whitehead W, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108(4):863–72.
doi: 10.1097/01.AOG.0000232504.32589.3b
pubmed: 17012447
Nielsen TF, Hokegard KH. Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol. 1983;146(8):911–6.
doi: 10.1016/0002-9378(83)90963-8
pubmed: 6881224
Hatch Q, Champagne BJ, Maykel JA, Davis BR, Johnson EK, Bleier JS, et al. Crohn’s Disease and pregnancy: the impact of perianal Disease on delivery methods and Complications. Dis Colon Rectum. 2014;57(2):174–8.
doi: 10.1097/DCR.0b013e3182a41381
pubmed: 24401878
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329(26):1905–11.
doi: 10.1056/NEJM199312233292601
pubmed: 8247054
Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29(1):7–18.
doi: 10.1055/s-0031-1285829
pubmed: 21833896
van der Woude CJ, Kolacek S, Dotan I, Øresland T, Vermeire S, Munkholm P, et al. European evidenced-based consensus on reproduction in inflammatory bowel Disease. J Crohns Colitis. 2010;4(5):493–510.
doi: 10.1016/j.crohns.2010.07.004
pubmed: 21122553
Bradford K, Melmed GY, Fleshner P, Silverman N, Dubinsky MC. Significant variation in recommendation of care for women of reproductive age with ulcerative Colitis postileal pouch-anal anastomosis. Dig Dis Sci. 2014;59(6):1115–20.
doi: 10.1007/s10620-014-3043-4
pubmed: 24549832
Nørgård B, Hundborg HH, Jacobsen BA, Nielsen GL, Fonager K. Disease activity in pregnant women with Crohn’s Disease and birth outcomes: a regional Danish cohort study. Am J Gastroenterol. 2007;102(9):1947–54.
doi: 10.1111/j.1572-0241.2007.01355.x
pubmed: 17573787
Kornfeld D, Cnattingius S, Ekbom A. Pregnancy outcomes in women with inflammatory bowel disease–a population-based cohort study. Am J Obstet Gynecol. 1997;177(4):942–6.
doi: 10.1016/S0002-9378(97)70298-9
pubmed: 9369849
Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcomes in women with inflammatory bowel Disease: a large community-based study from Northern California. Gastroenterology. 2007;133(4):1106–12.
doi: 10.1053/j.gastro.2007.07.019
pubmed: 17764676
Bröms G, Granath F, Linder M, Stephansson O, Elmberg M, Kieler H. Birth outcomes in women with inflammatory bowel Disease: effects of Disease activity and drug exposure. Inflamm Bowel Dis. 2014;20(6):1091–8.
pubmed: 24810137
O’Toole A, Nwanne O, Tomlinson T. Inflammatory bowel Disease increases risk of adverse pregnancy outcomes: a Meta-analysis. Dig Dis Sci. 2015;60(9):2750–61.
doi: 10.1007/s10620-015-3677-x
pubmed: 26070523
Foulon A, Dupas JL, Sabbagh C, Chevreau J, Rebibo L, Brazier F, et al. Defining the most appropriate delivery Mode in Women with Inflammatory Bowel Disease: a systematic review. Inflamm Bowel Dis. 2017;23(5):712–20.
doi: 10.1097/MIB.0000000000001112
pubmed: 28426452
Malhi G, Tandon P, Perlmutter JW, Nguyen G, Huang V. Risk factors for Postpartum Disease Activity in Women with Inflammatory Bowel Disease: a systematic review and Meta-analysis. Inflamm Bowel Dis. 2022;28(7).
Smink M, Lotgering FK, Albers L, de Jong DJ. Effect of Childbirth on the course of Crohn’s Disease; results from a retrospective cohort study in the Netherlands. BMC Gastroenterol. 2011;11.
Rekawek P, Bigelow C, Getrajdman C, Roy-McMahon C, Johnson S, Mella MT. Inflammatory bowel Disease and biologic use during pregnancy and its Association with Postpartum Disease activity [20 M]. Obstet Gynecol. 2020;135:140S.
doi: 10.1097/01.AOG.0000664788.61467.a3
Bennett A, Mamunes A, Kim M, Duley C, Garrett A, Annis K, et al. The importance of Monitoring the Postpartum period in moderate to severe Crohn’s Disease. Inflamm Bowel Dis. 2022;28(3):409–14.
doi: 10.1093/ibd/izab104
pubmed: 33999196
Lichtenstein GR, Feagan BG, Mahadevan U, Salzberg BA, Langholff W, Morgan GJ, et al. Pregnancy outcomes reported during the 13-Year TREAT Registry: a descriptive report. Am J Gastroenterol. 2018;113(11):1678–88.
doi: 10.1038/s41395-018-0202-9
pubmed: 30022113
Yu A, Friedman S, Ananthakrishnan AN. Incidence and predictors of flares in the Postpartum Year among Women with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2020;26(12):1926–32.
doi: 10.1093/ibd/izz313
pubmed: 31895410
pmcid: 7676422
Grouin A, Brochard C, Siproudhis L, Leveque J, Bretagne JF, Poulain P, et al. Perianal Crohn’s Disease results in fewer pregnancies but is not exacerbated by vaginal delivery. Dig Liver Dis. 2015;47(12):1021–6.
doi: 10.1016/j.dld.2015.08.001
pubmed: 26342947
Cheng AG, Oxford EC, Sauk J, Nguyen DD, Yajnik V, Friedman S, et al. Impact of mode of delivery on outcomes in patients with perianal Crohn’s Disease. Inflamm Bowel Dis. 2014;20(8):1391–8.
doi: 10.1097/MIB.0000000000000093
pubmed: 24918322
Argüelles-Arias F, Castro-Laria L, Barreiro-de-Acosta M, García-Sánchez MV, Guerrero-Jiménez P, Gómez-García MR, et al. Is safety infliximb during pregnancy in patients with inflammatory bowel Disease? Rev Esp Enferm Dig. 2012;104(2):59–64.
doi: 10.4321/S1130-01082012000200003
pubmed: 22372798