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Impact of Mode of Delivery on Outcomes in Patients with Perianal Crohn's Disease

Cheng, Alice G. MD*; Oxford, Emily C. BS; Sauk, Jenny MD*,†,‡; Nguyen, Deanna D. MD*,†,‡; Yajnik, Vijay MD, PhD*,†,‡; Friedman, Sonia MD‡,§; Ananthakrishnan, Ashwin N. MD, MPH*,†,‡

doi: 10.1097/MIB.0000000000000093
Original Clinical Articles

Background: Crohn's disease (CD) often affects women during the reproductive years. Although several studies have examined the impact of pregnancy on luminal disease, limited literature exists in those with perianal CD. Decision regarding mode of delivery is a unique challenge in such patients due to concerns regarding the effect of pelvic floor trauma during delivery on preexisting perianal involvement.

Methods: We performed a retrospective chart review of patients with CD with established perianal disease undergoing either vaginal delivery or caesarean section (C-section) at our institutions. We examined the occurrence of symptomatic perianal disease flares within 5 years after delivery in such women compared with nonpregnant CD controls. We also compared the occurrence of such flares between the 2 modes of delivery in women with established perianal CD.

Results: We identified 61 pregnant patients with CD with established perianal disease (11 vaginal delivery, 50 through C-section) and 61 nonpregnant CD controls with perianal disease. One-third of the C-sections were primarily for obstetric indications. Six of the vaginal deliveries were complicated. Approximately, 36% of cases had a symptomatic perianal flare within 1 year after delivery. This was similar across both modes of delivery (P = 0.53) and similar to nonpregnant patients with CD. There was no difference in the rates of perianal surgical intervention or luminal disease flares in our population based on mode of delivery or between pregnant patients with CD and nonpregnant CD controls.

Conclusions: We observed no difference in risk of symptomatic perianal flares in patients with established perianal CD delivering vaginally or through C-section.

Article first published online 10 June 2014.

*Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;

Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts;

Harvard Medical School, Boston, Massachusetts; and

§Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

Reprints: Ashwin N. Ananthakrishnan, MD, MPH, Crohn's and Colitis Centre, Gastrointestinal Unit, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114 (e-mail:

Supported by the National Institutes of Health (NIH) (P30 DK043351) to the Center for Study of Inflammatory Bowel Diseases. A. N. Ananthakrishnan is supported in part by a grant from the NIH (K23 DK097142).

A. N. Ananthakrishnan is in Scientific advisory board for Cubist pharmaceuticals, Abbvie. The other authors have no conflicts of interest to disclose.

Received April 22, 2014

Accepted April 30, 2014

© Crohn's & Colitis Foundation of America, Inc.
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