Abstract
Background
Despite a high prevalence of Crohn's disease in women of childbearing age, disease-related
factors that may impact fertility and perianal Crohn's disease after delivery remain
unclear.
Methods
Self-administered questionnaires related to childbirth were completed by women with
Crohn's disease referred to a single gastroenterology unit. A survival analysis was
performed for statistical purposes.
Results
A total of 184 patients were assessed, including 63 nulliparous women. The cumulative
probabilities of having a child were 30%, 51% and 72% at the ages of 25, 30 and 35
years, respectively. Women with colonic disease, prior abdominal surgery and perianal
disease were less likely to experience childbirth. After a median follow-up of 165
weeks post-delivery, the cumulative probabilities of fistulizing perianal Crohn's
disease occurrence were 8%, 12% and 21% at 1, 2 and 5 years following childbirth,
respectively. Contrary to a prior history of perianal Crohn's disease and colonic
location, mode of delivery was not associated with perianal fistula. An episiotomy
in the group of women with prior anal lesions did not result in a higher rate of fistula
recurrence.
Conclusion
Perianal Crohn's disease is associated with fewer pregnancies, however perianal fistulas
were less affected by obstetric events than their own natural history.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology and natural history of inflammatory bowel diseases.Gastroenterology. 2011; 140: 1785-1794
- The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics.American Journal of Gastroenterology. 2011; 106: 214-223
- Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample.Gastroenterology. 2002; 122: 15-19
- Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis.Gut. 2006; 55: 1575-1580
- Systematic review: fertility in non-surgically treated inflammatory bowel disease.Alimentary Pharmacology and Therapeutics. 2013; 38: 847-853
- Voluntary childlessness is increased in women with inflammatory bowel disease.Inflammatory Bowel Diseases. 2007; 13: 591-599
- Nonfistulizing perianal Crohn's disease: clinical features, epidemiology, and treatment.Inflammatory Bowel Diseases. 2010; 16: 1431-1442
- Quality of life in perianal Crohn's disease: what do patients consider important.Diseases of the Colon and Rectum. 2011; 54: 579-585
- AGA technical review on perianal Crohn's disease.Gastroenterology. 2003; 125: 1508-1530
- The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: special situations.Journal of Crohn's and Colitis. 2010; 4: 63-101
- Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn's disease.American Journal of Gastroenterology. 1995; 90: 1918-1922
- Perianal Crohn's disease and pregnancy: role of the mode of delivery.American Journal of Gastroenterology. 1999; 94: 3274-3278
- Mode of delivery and risk of fecal incontinence in women with or without inflammatory bowel disease: questionnaire survey.Inflammatory Bowel Diseases. 2007; 13: 1391-1394
- The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications.Gut. 2006; 55: 749-753
- Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions.Inflammatory Bowel Diseases. 2009; 15: 720-725
- Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views.Journal of Crohn's and Colitis. 2013; 7: 206-213
- Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature.Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 2005; 34: 581-588
- Effect of childbirth on the course of Crohn's disease: results from a retrospective cohort study in the Netherlands.BMC Gastroenterology. 2011; 11: 6
- Operative delivery data in France for 2007: results of a national survey within teaching hospitals.Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 2010; 39: 121-132
Article info
Publication history
Published online: September 02, 2015
Accepted:
August 3,
2015
Received:
April 2,
2015
Identification
Copyright
© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Inc. All rights reserved.
