Does Surgery Before Pregnancy in Women With Inflammatory Bowel Disease Increase the Risk of Adverse Maternal and Fetal Outcomes? A Danish National Cohort Study

Abstract

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. We aimed to assess maternal/fetal outcomes in women with CD or UC who underwent surgeries before pregnancy. METHODS: In this nationwide study, we included all pregnancies in women with CD or UC from 1997 to 2022 and examined 6 categories of CD and UC surgeries before pregnancy. We used multilevel logistic regression to compute crude and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) for the risk of pregnancy and offspring complications in women who did, vs did not, undergo surgery before pregnancy. RESULTS: There were 833 UC and 3,150 CD pregnancies with prior surgery and 12,883 UC and CD 6,972 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 C-section and certain perinatal complications in patients with CD or UC surgery before pregnancy.