The impact of pregnancy on surgical Crohn disease: an analysis of the Nationwide Inpatient Sample.

Abstract

BACKGROUND:

The impact of pregnancy on the course of Crohn disease is largely unknown. Retrospective surveys have suggested a variable effect, but there are limited population-based clinical data. We hypothesized pregnant women with Crohn disease will have similar rates of surgical disease as a nonpregnant Crohn disease cohort.

MATERIAL AND METHODS:

International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify female Crohn patients from all patients admitted using the Nationwide Inpatient Sample (1998-2009). Women were stratified as either pregnant or nonpregnant. We defined Crohn-related surgical disease as peritonitis, gastrointestinal hemorrhage, intra-abdominal abscess, toxic colitis, anorectal suppuration, intestinal-intestinal fistulas, intestinal-genitourinary fistulas, obstruction and/or stricture, or perforation (excluding appendicitis).

RESULTS:

Of the 92,335 women admitted with a primary Crohn-related diagnosis, 265 (0.3%) were pregnant. Pregnant patients were younger (29 versus 44 y; P<0.001) and had lower rates of tobacco use (6% versus 13%; P<0.001). Pregnant women with Crohn disease had higher rates of intestinal-genitourinary fistulas (23.4% versus 3.0%; P<0.001), anorectal suppuration (21.1% versus 4.1%; P<0.001), and overall surgical disease (59.6% versus 39.2%; P<0.001). On multivariate logistic regression analysis controlling for malnutrition, smoking, age, and prednisone use, pregnancy was independently associated with higher rates of anorectal suppuration (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.8-7.0; P<0.001), intestinal-genitourinary fistulas (OR, 10.4; 95% CI, 7.8-13.8; P<0.001), and overall surgical disease (OR, 2.9; 95% CI, 2.3-3.7; P<0.001).

CONCLUSIONS:

Pregnancy in women with Crohn disease is a significant risk factor for Crohn-related surgical disease, in particular, anorectal suppuration and intestinal-genitourinary fistulas.

• Authors: Quinton Hatch, Bradley J Champagne, Justin A Maykel, Bradley R Davis, Eric K Johnson, Joshua I Bleier, Todd D Francone, Scott R Steele
• Journal: The Journal of surgical research (J Surg Res) Vol. 190 Issue 1 Pg. 41-6 (Jul 2014) ISSN: 1095-8673 [Electronic] United States
• PMID: 24742624 (Publication Type: Journal Article)
• Copyright: Published by Elsevier Inc.

Topics

• Adult
• Crohn Disease (surgery)
• Female
• Humans
• Inpatients
• Logistic Models
• Pregnancy
• Pregnancy Complications (surgery)
• Retrospective Studies