Background: Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. Aim: To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. Design: The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. Patients and setting: A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. Results: For women with IBD, there was a 1.87-fold increase in incidence of prematurity (,37 weeks gestation; 95% CI 1.52 to 2.31; p,0.001) compared with controls. The incidence of low birth weight (,2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p,0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p,0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p,0.001). Conclusion:The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.

This study provides evidence of an association between the use of oral contraceptive agents and development of IBD, in particular CD. The study also suggests that the risk for patients who stop using the OCP reverts to that of the nonexposed population.

SUMMARY BackgroundAlvimopan is a selective, competitive l-opioid receptor antagonist with limited oral bioavailability which may be used to reduce length of postoperative ileus.

Laparoscopic colposuspension results in a significant reduction in hospital stay and earlier return to work, with a possible increased risk of bladder injury. When performed by appropriately experienced surgeons it may be a safe option with advantages for the patient, but further randomized controlled trials should be undertaken to evaluate continence in the longer term at 5 years.