Global 
Deutschland Colon to Rectum
Am J Gastroenterol. 2024;119(9):1875-1884
Does surgery before pregnancy in women with inflammatory bowel disease increase the risk of adverse maternal and fetal outcomes? A Danish national cohort study
Introduction: Up to 15% of women with Crohn’s disease (CD) or ulcerative colitis (UC) undergo bowel surgery before pregnancy, and there is little data on pregnancy outcomes in this population. The authors aimed to assess maternal/fetal outcomes in women with CD or UC who underwent surgeries before pregnancy.
Methods: In this nationwide study, the authors included all pregnancies in women with CD or UC from 1997 to 2022 and examined 6 categories of CD and UC surgeries before pregnancy. They used multilevel logistic regression to compute crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) for the risk of pregnancy and offspring complications in women who did, versus did not, undergo surgery before pregnancy.
Results: There were 833 UC and 3150 CD pregnancies with prior surgery and 12,883 UC and 6972 CD pregnancies without surgery. For UC, prior surgery was associated with Cesarian section (C-section) (ileoanal pouch: aOR = 20.03 [95% CI: 10.33–38.83]; functional ileostomy: aOR = 8.55 [6.10–11.98]; diverting ileostomy: aOR = 38.96 [17.05–89.01]) and preterm birth (aOR = 2.25 [1.48–3.75]; 3.25 [2.31–4.59]; and 2.17 [1.17–4.00]) respectively. For CD and prior intestinal surgery, the risks of C-section (aOR = 1.94 [1.66–2.27]), preterm birth (aOR = 1.30 [1.04–1.61]), and low 5-minute Apgar (aOR = 1.95 [95% CI: 1.07–3.54]) increased and premature rupture of membranes (aOR = 0.68 [0.52–0.89]) decreased. For CD with only prior perianal surgery, the risk of C-section (aOR = 3.02 [2.31–3.95]) increased and risk of gestational hypertension/preeclampsia/eclampsia (aOR = 0.52 [0.30–0.89]) decreased.
Discussion: Providers should be aware there is an increased likelihood of Cesarian section and certain perinatal complications in patients with Crohn’s disease or ulcerative colitis surgery before pregnancy.