Active Crohn’s disease complicates pregnancy and childbirth
MedWire News: Women with active Crohn's disease (CD), particularly of the perianal region, are more likely to require a cesarean section than women with inactive CD, say researchers.
They also observed that women with active CD are more likely to have complications during pregnancy and have more frequent disease progression after childbirth than those with inactive disease.
Dirk de Jong (Radbound University Nijmegen Medical Centre, The Netherlands) and colleagues carried out a retrospective study using information from an inflammatory bowel disease database to address a lack of in-depth information and guidance about possible maternal and fetal risks during pregnancy and childbirth for women with CD.
The researchers included 114 women with at least one pregnancy after being diagnosed with CD. The patients were aged a median of 44 years in 2004 when they filled out questionnaires to assess their eligibility for the study, with a median age at index pregnancy (ie, pregnancy with data included in the study) of 30 years.
Overall, 21 (18%) women had active luminal disease before becoming pregnant. The women with active disease had 2.8 times as many pregnancy related complications (baby small for gestational age, pregnancy induced hypertension, intrauterine death, or other) than those with inactive luminal disease.
The authors found that the rate of cesarean section was relatively high in this cohort, at 32.0%, compared with the 13.6% incidence seen in the general population of The Netherlands. Women with perianal disease (n=27) had a particularly high 4.6-fold increased risk for cesarean section compared with those without perianal disease.
CD progression following childbirth was a significant 9.7 times more likely in women with active versus inactive luminal disease. Progression of perianal CD was less frequent after vaginal than cesarean delivery, at 18% versus 31% and 5% versus 14% in women with and without prior perianal disease, respectively.
Of note, fistula-related complications occurred to a similar degree after childbirth in women who did and did not experience episiotomy or a second degree tear, suggesting that episiotomy may not worsen CD symptoms in such women.
"In the absence of more rigorous data, the results of the present study support the recommendation that in women with inactive luminal disease elective caesarean section should be performed for obstetric indications only, whereas in patients with pre-existent active perianal disease the advantages and disadvantages of caesarean section versus vaginal delivery should be weighted on an individual basis," write de Jong et al.
They add: "In the absence of proof of any protective or deteriorating effect of episiotomy, it would seem good practice to use episiotomy for obstetric indications only."
The results of this study are published in the journal BMC Gastroenterology.
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By Helen Albert