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


METHODS
This 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.


RESULTS
21/114 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.


CONCLUSIONS
A 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.
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
Marieke
M
Smink
Frederik K
FK
Lotgering
Lisette
L
Albers
Dirk J
DJ
de Jong
D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000150:complications* / Q000503:physiopathology; D002585:Cesarean Section; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000150:complications* / Q000503:physiopathology; D036861:Delivery, Obstetric; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult
BMJ. 2008 Jul 03;337:a427
18599468
Obstet Gynecol. 1983 Aug;62(2):247-52
6346173
Am J Epidemiol. 1999 Jun 1;149(11):981-3
10355372
Gastroenterol Clin North Am. 2003 Mar;32(1):323-40
12635421
Am J Gastroenterol. 1999 Nov;94(11):3274-8
10566729
Gut. 2007 Jun;56(6):830-7
17185356
Am J Perinatol. 1995 Jul;12(4):262-4
7575831
Inflamm Bowel Dis. 2000 Feb;6(1):8-15
10701144
Gastroenterol Clin North Am. 1998 Mar;27(1):213-24
9546091
Best Pract Res Clin Gastroenterol. 2007;21(5):819-34
17889810
World J Gastroenterol. 2008 Mar 7;14(9):1326-32
18322943
World J Gastroenterol. 2010 Jun 7;16(21):2591-9
20518079
Am J Obstet Gynecol. 2002 Sep;187(3):681-7
12237648
Dig Liver Dis. 2007 Oct;39(10):959-62
17720634
Gastroenterology. 2010 Feb;138(2):463-8; quiz e10-1
19818785
JAMA. 2000 May 10;283(18):2411-6
10815084
Eur J Obstet Gynecol Reprod Biol. 2007 May;132(1):70-5
16884843
Am J Gastroenterol. 1995 Nov;90(11):1918-22
7484992
Gut. 2006 Mar;55 Suppl 1:i36-58
16481630
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000081
19160176