title: Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases.
abstract: BACKGROUND
  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.
authors.affiliation: Division of Gastroenterology, Crohn's and Colitis Center, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA, aananthakrishnan@mgh.harvard.edu.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.forename: Alice
authors.initials: A
authors.lastname: Cheng
authors.forename: Andrew
authors.initials: A
authors.lastname: Cagan
authors.forename: Tianxi
authors.initials: T
authors.lastname: Cai
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Gainer
authors.forename: Stanley Y
authors.initials: SY
authors.lastname: Shaw
authors.forename: Susanne
authors.initials: S
authors.lastname: Churchill
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Karlson
authors.forename: Shawn N
authors.initials: SN
authors.lastname: Murphy
authors.forename: Isaac
authors.initials: I
authors.lastname: Kohane
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Liao
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston; D002585:Cesarean Section / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D036801:Parturition; D010359:Patient Readmission; D011247:Pregnancy; D011379:Prognosis; D016016:Proportional Hazards Models; D012003:Rectal Fistula / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D007155:Immunologic Factors