Significant Variation in Recommendation of Care for Women of Reproductive Age with Ulcerative Colitis Postileal Pouch–Anal Anastomosis

Bradford, Kara; Melmed, Gil Y.; Fleshner, Phillip; Silverman, Neil S.; Dubinsky, Marla

doi:10.1007/s10620-014-3043-4

Cited by 23 publications

(14 citation statements)

References 22 publications

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“…41 The standard indications for a caesarean section for women with IBD, aside from obstetric indications, are active perianal disease and previous pouch surgery; however, there may be significant variation between clinicians in recommendations of care for women of reproductive age with UC and an ileo-pouch anastomosis. 42 An association between birth by caesarean section and an increase in subsequent development of IBD particularly in childhood and young adulthood, has previously been reported, 43 so caesarean section for nonobstetric or nongastrointestinal indications should be carefully considered. Multidisciplinary discussion involving colorectal surgery, gastroenterology and obstetrics to determine the optimal mode of birth for an individual woman is recommended.…”

Section: Discussionmentioning

confidence: 98%

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Shand

Chen

Selby

et al. 2016

BJOG

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Objective To determine the prevalence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), in pregnant women and determine pregnancy and fetal/neonatal outcomes.Design Population-based cohort study.Setting New South Wales, Australia, 2001-11.Population A total of 630 742 women who delivered at ≥20 weeks of gestation.Methods Descriptive and multivariate regression analyses of perinatal data linked to hospital admission data. We compared birth outcomes of women with and without a documented diagnosis of IBD.Main outcome measures Caesarean section, severe maternal morbidity, preterm birth <37 weeks of gestation, planned preterm birth, small-for-gestational-age (birthweight <10th centile), perinatal mortality (stillbirth/neonatal death ≤28 days).Results In all, 1960 women (0.31%) with IBD, who had 2781 births (1183 UC, 1287 CD and 311 IBD-indeterminate). Women with IBD were more likely than women without IBD to have a caesarean section [41.5 versus 28.2%, adjusted risk ratio (aRR) 1.38, 95% CI 1.31-1.45], severe maternal morbidity (2.6 versus 1.6%, aRR 1.54, 95% CI 1.17-2.03), preterm birth (9.7 versus 6.6%, aRR 1.47, 95% CI 1.30-1.66), planned preterm birth (5.3 versus 2.9%, aRR 1.74, 95% CI 1.47-2.07), and their infants to be small-for-gestational-age (9.7 versus 9.5%, aRR 1.19, 95% CI 1.04-1.36). There was no evidence of a difference in perinatal mortality.Conclusion Pregnancy-associated IBD is more common than previously reported. Pregnancies complicated by IBD at or near the time of birth have significantly higher rates of adverse pregnancy outcomes than pregnancies of women without IBD.Keywords Crohn's disease, inflammatory bowel disease, population-based, pregnancy, ulcerative colitis.Tweetable abstract Increased rates preterm birth and caesarean section in women with inflammatory bowel disease.Please cite this paper as: Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes.

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Section: Discussionmentioning

confidence: 98%

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Shand

Chen

Selby

et al. 2016

BJOG

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“…Delivery decisions in women with IPAA are complex, and women frequently receive conflicting advice from various specialists, 136 which partly reflects the inconclusive data in the literature. During pregnancy, women with IPAA may experience an increased stool frequency which returns to baseline 3 months post-partum, irrespective of delivery modality.…”

Section: Management Of Ibd During Pregnancymentioning

confidence: 99%

Review of pregnancy in Crohn’s disease and ulcerative colitis

Laube

Paramsothy

Leong

2021

Therap Adv Gastroenterol

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Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch–anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.

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“…A study conducted by Cornish et al demonstrated that women with UC have a cesarean section rate compared with the general population unlike women with CD, who are more prone to undergo C-sections [13]. Bradford et al illustrate that C-sections remains more prevalent among women with IBD, most likely due to peri-anal disease, in addition to the other obstetric complications [26]. According to the European Crohn's and Colitis Organization, C-section remains a mandate in women who develop the active perianal disease during pregnancy, owing to the increased risk of complications to both the mother and the child.…”

Section: Reviewmentioning

confidence: 99%

“…Methotrexate: Methotrexate acts by Inhibiting enzymes in the metabolic pathway of folic acid interfering in purine and pyrimidine synthesis [26], making it devastating for both the mother and the fetus. The drug is categorized as FDA class X.…”

Section: Reviewmentioning

confidence: 99%

The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review

Pervez¹,

Usman²,

Ahmed³

et al. 2019

Cureus

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Inflammatory bowel disease (IBD) is a constellation of devastating chronic inflammatory changes in the bowel, either involving the large or small bowel or part of both. As it is widely diagnosed in the fertile age group, this disorder can present itself, very commonly, during pregnancy and thus a better understanding of the disease can be an important factor to influence the maternal and fetal well-being. Medications are what is considered the first line in the management of this disease to control the symptoms or keep the disease in remission. In addition to this, the drugs used to keep the disease in remission can also cause significant adverse effects on the patient and the new nurturing life preparing itself for the outside world. What the fetus gets from the mother will stay for life with the child. We conducted an electronic literature review search which highlights the significance and impact of sustained remission of IBD and the cautious use of various drugs during pregnancy for that purpose. In addition to the influences already mentioned, It is evident that nutritional deficiencies can also prevail with the advancing disease, something to manage as a side note as well. These deficiencies can have a definite effect on the fetus and may cause developmental malformations. In order to avoid this process, a systemic and joint approach should be curtailed. This can reduce the adverse outcomes associated with this ailment during pregnancy.

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Significant Variation in Recommendation of Care for Women of Reproductive Age with Ulcerative Colitis Postileal Pouch–Anal Anastomosis

Abstract: There is significant intra- and inter-group variation in management of women post-IPAA. There is need for consensus among subspecialists involved in managing women with this complex condition.

Cited by 23 publications

References 22 publications

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Inflammatory bowel disease in pregnancy: a population‐based study of prevalence and pregnancy outcomes

Review of pregnancy in Crohn’s disease and ulcerative colitis

The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review

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