title: Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England.
abstract: OBJECTIVE
  To determine the absolute and relative risk of acute appendicitis during the antepartum and postpartum periods compared with the time outside pregnancy among women of childbearing age.
  
  
  BACKGROUND
  Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy. Estimates of the incidence of acute appendicitis in pregnancy remain imprecise and inconsistent.
  
  
  METHODS
  All potential fertile women aged 15 to 44 years registered within Clinical Practice Research Datalink with linkages to the Hospital Episodes Statistics between 1997 and 2012 were identified. Absolute rates of acute appendicitis were calculated during the antepartum and postpartum periods and were compared with the time outside pregnancy in terms of incidence rate ratio (IRR) using a Poisson regression model.
  
  
  RESULTS
  Among 1,624,804 women, there were 362,219 pregnancies resulting in live or stillbirths. Compared with the time outside pregnancy, the rate of acute appendicitis was 35% lower during the antepartum period [IRR, 0.65; 95% confidence interval (CI), 0.55-0.76], with the lowest rate reported during the third trimester (IRR, 0.47; 95% CI, 0.35-0.64) for all ages; no increased risk of acute appendicitis was observed in the postpartum period compared with the time outside pregnancy among women aged 15 to 34 years but an 84% increased risk for women older than 35 years (IRR, 1.84; 95% CI, 1.18-2.86). The highest and lowest rates of negative appendectomy were encountered in the second and the third trimesters, respectively.
  
  
  CONCLUSIONS
  Pregnant women are less likely to be diagnosed with acute appendicitis than nonpregnant women, with the lowest risk reported during the third trimester.
authors.affiliation: *Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, United Kingdom; and †Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Zingone
authors.forename: Alyshah Abdul
authors.initials: AA
authors.lastname: Sultan
authors.forename: David James
authors.initials: DJ
authors.lastname: Humes
authors.forename: Joe
authors.initials: J
authors.lastname: West
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D016012:Poisson Distribution; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011645:Puerperal Infection / Q000453:epidemiology; D012306:Risk; D055815:Young Adult