Inflammatory bowel disease and preterm delivery.
ABSTRACT The present study investigates pregnancy outcome in women with IBD and examines the effect of pregnancy on the severity of IBD.
A case-control study comparing deliveries by mothers with IBD between January 1988 and January 2005 was performed. For every birth by a mother with IBD, four births by non-IBD mothers were randomly selected and adjusted for ethnicity and year of delivery.
During the study period there were 48 deliveries to patients with Crohn's disease and 79 deliveries to patients with ulcerative colitis. Higher rates of preterm delivery (<37 weeks) were found among patients with IBD as compared to the controls (odds ratios (OR)=2.2; 95% confidence interval (CI)=1.3-3.8). This association remained significant after adjustment for labor induction and multiple gestations, using the Mantel-Haenszel technique (weighted OR=2.1; 95% CI 1.3-3.5 and weighted OR=2.0; 95% CI 1.2-3.5; P=0.012; respectively). In addition, these patients had higher rates of fertility treatments (OR=2.2; 95% CI=1.1-4.4). Using a multivariate analysis, controlling for maternal age and fertility treatments, preterm delivery was seen to be significantly associated with IBD (adjusted OR=2.0; 95% CI=1.2-3.5). Perinatal outcomes, such as perinatal mortality, low Apgar scores, and congenital malformations, were comparable to the outcomes in the control group.
Maternal IBD is an independent risk factor for preterm delivery. IBD is not associated with adverse perinatal outcome.
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ABSTRACT: To evaluate the effects of inflammatory bowel diseases (IBDs) on human reproduction, we reviewed the current literature using a systematic search for published studies (articles and/or abstracts) without limits for English language. We searched on Medline (through PubMed), the Institute for Scientific Information, the Web of Science and the websites for the registration of controlled trials (http://controlled-trials.com/). Bibliographies of retrieved articles, books, expert opinion review articles and reviewed bibliographies from subject experts were manually searched. Titles and abstracts were screened initially, and potential relevant articles were identified and reviewed. Whenever possible, data were analyzed by comparing IBD patients vs healthy controls, and patients with active IBDs vs those with disease in remission. The effects of IBDs on female fertility, fertility in infertile couples, pregnancy and male infertility were examined separately. Patients with IBDs in remission have normal fertility. At the moment, there is no established guideline for the preservation of fertility in women with IBD undergoing surgery. Further data are needed regarding guidelines for the management of these patients. Data regarding IBDs and infertility are currently completely lacking. Considering the prevalence of intestinal pathology in young adults of childbearing age, this field is of great scientific and clinical interest, opening up important future perspectives. Another important and as yet unexplored point is the response to treatments for infertility in patients with IBDs. In particular, the question is whether the reproductive outcomes (clinical and biological) can be influenced by the IBD of one of the partners. The goals for successful reproductive outcomes in IBD population are correct counseling and disease remission. IBDs significantly affect several reproductive aspects of human (female, male, couple) reproduction. Further data are needed to develop guidelines for the clinical management of subjects of reproductive age with IBDs.World Journal of Gastroenterology 06/2014; 20(23):7123-7136. DOI:10.3748/wjg.v20.i23.7123 · 2.43 Impact Factor
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ABSTRACT: Abstract Objective. It has been considered that cesarean delivery is a risk factor for the two subtypes of inflammatory bowel diseases (IBDs): Crohn's disease (CD) and ulcerative colitis (UC). The aim of this meta-analysis was to examine the relationship between cesarean delivery and the development of IBD. Material and methods. We searched the articles retrieved by PubMed, MEDLINE and EMBASE databases to identify observational studies regarding the relationship between cesarean section and the development of CD and/or UC. Pooled odds ratios were calculated for each relationship. Results. Nine studies evaluated the potential association between cesarean delivery and the development of IBD and met all of our inclusion criteria. The pooled data from six included studies indicated cesarean delivery was a risk factor for CD (95% confidence interval [CI]: 1.12-1.70; p = 0.003). Likewise, we observed a positive association between cesarean delivery and pediatric CD (95% CI: 1.06-1.35; p = 0.005). However, results from the four included studies for UC indicated the rate of cesarean section in UC patients was not higher than that of control subjects (95% CI: 0.87-1.32; p = 0.54). Overall, we did not observe a positive relationship between cesarean delivery and IBD (95% CI: 0.99-1.30; p = 0.08). Conclusion. Results of this meta-analysis support the hypothesis that cesarean delivery was associated with the risk of CD but not of UC. The total rate of cesarean delivery of IBD patients was similar with that of control subjects.Scandinavian Journal of Gastroenterology 06/2014; 49(7):1-11. DOI:10.3109/00365521.2014.910834 · 2.33 Impact Factor
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ABSTRACT: Background It is possible to control Crohn’s disease by dietary therapy involving the detection and exclusion from the patient’s diet of foods which provoke symptoms. The effects of such treatment on pregnancy have not been studied in detail. Aim To determine the outcomes and complications in pregnancies occurring in women with Crohn’s disease receiving dietary therapy. Methods A review by retrospective questionnaire and the contemporaneous medical and dietetic notes over a period of five years of women attending the department of gastroenterology at Addenbrookes hospital, Cambridge for treatment of Crohn’s disease by diet. Results Forty seven pregnancies occurred in thirty four women. At conception, 51% of women were in remission, 40% had mildly active disease and 9 % active disease. During pregnancy 78% remained stable or improved. Delivery was by caesarean section in 25%. The incidence of miscarriage (21%), stillbirths (2%), congenital abnormality (0%), prematurity (10%) and low birth weight (5%) were not different from those expected in the general population. Food intolerances improved during pregnancy in 66%. Nevertheless 55% relapsed within 3 months post-partum. Conclusions The incidence of complications of pregnancy was no greater than those observed in the healthy British population. Dietary treatment in pregnancy appears to be safe but relapse after delivery is common.10/2014; DOI:10.1016/j.clnme.2014.07.001