Issue 14

Clinical Question

Does IBD affect the mode of delivery in childbirth and does the mode of delivery affect IBD?

Editor’s Bottom Line

The presence of perianal disease leads to increased rates of caesarean sections. The mode of delivery does not affect the severity or course of IBD.

Reference

Ananthakrishnan AN, Cheng A, Cagan A, et al. Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases. Dig Dis Sci. 2015;60:471–477. https://www.ncbi.nlm.nih.gov/pubmed/25213079

Synopsis

From an established cohort of 11,028 patients with IBD (Partners Healthcare network comprised of 2 tertiary hospitals and associated medical centres), ICD 9 codes were used to identify women (18-45 years of age) who had at least 1 pregnancy and delivery. Only the first pregnancy and delivery after the diagnosis of IBD was included in this study. Pregnancies ending in spontaneous abortion were excluded from the study. During the follow-up after delivery (median: 4 years), the following outcomes were assessed: changes in medication, hospitalizations, and IBD-related surgeries.

The final cohort of 360 women (CD, 86; UC, 114) were followed for a mean of 2 years prior to pregnancy and 4 years after delivery. No details as to the number of live births and infants were reported. There were 161 C- sections (CD, 47%; UC, 53%) versus 198 vaginal deliveries (CD, 39%; UC, 61%).

There was no significant difference reported for mode of delivery and IBD type. However, women with perianal or complex diseases had significantly more C-sections than vaginal deliveries, and women who were older at time of pregnancy were also more likely to have a C-section.

In the 133 women with CD and no history of perianal disease, the mode of delivery did not increase the risk of perianal fistulae during follow-up.

During follow-up, no significant differences between the mode of delivery were reported for initiation of either immunosuppressants or anti-TNF therapies, IBD-related hospitalizations, or IBD-related surgeries.

Details

Study Design: Retrospective observational cohort study

Funding: US National Institutes of Health, American Gastroenterological Association, Harold and Duval Bowen Fund
Allocation: n/a
Setting: Partners Healthcare network in Boston, MA
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.