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Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases.

ABSTRACT: Inflammatory bowel diseases [IBD; Crohn's disease (CD), ulcerative colitis] often affect women in their reproductive years. Few studies have analyzed the impact of mode of childbirth on long-term IBD outcomes.We used a multi-institutional IBD cohort to identify all women in the reproductive age-group with a diagnosis of IBD prior to pregnancy. We identified the occurrence of a new diagnosis code for perianal complications, IBD-related hospitalization and surgery, and initiation of medical therapy after either a vaginal delivery or caesarean section (CS). Cox proportional hazards models adjusting for potential confounders were used to estimate independent effect of mode of childbirth on IBD outcomes.Our cohort included 360 women with IBD (161 CS). Women in the CS group were likely to be older and more likely to have complicated disease behavior prior to pregnancy. During follow-up, there was no difference in the likelihood of IBD-related surgery (multivariate hazard ratio 1.75, 95 % confidence interval (CI) 0.40-7.75), IBD-related hospitalization (HR 1.39), initiation of immunomodulator therapy (HR 1.45), or anti-TNF therapy (HR 1.11). Among the 133 CD pregnancies with no prior perianal disease, we found no excess risk of subsequent new diagnosis perianal fistulae with vaginal delivery compared to CS (HR 0.19, 95 % CI 0.04-1.05).Mode of delivery did not influence natural history of IBD. In our cohort, vaginal delivery was not associated with increased risk of subsequent perianal disease in women with CD.

SUBMITTER: Ananthakrishnan AN

PROVIDER: S-EPMC4304947 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases.

Ananthakrishnan Ashwin N AN Cheng Alice A Cagan Andrew A Cai Tianxi T Gainer Vivian S VS Shaw Stanley Y SY Churchill Susanne S Karlson Elizabeth W EW Murphy Shawn N SN Kohane Isaac I Liao Katherine P KP

Digestive diseases and sciences 20140912 2

<h4>Introduction</h4>Inflammatory bowel diseases [IBD; Crohn's disease (CD), ulcerative colitis] often affect women in their reproductive years. Few studies have analyzed the impact of mode of childbirth on long-term IBD outcomes.<h4>Methods</h4>We used a multi-institutional IBD cohort to identify all women in the reproductive age-group with a diagnosis of IBD prior to pregnancy. We identified the occurrence of a new diagnosis code for perianal complications, IBD-related hospitalization and surg ...[more]

PMID: 25213079

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Project description:BackgroundReal-world data on long-term outcomes of vedolizumab (VDZ) are scarce.ObjectiveTo assess long-term outcomes (up to 3 years) of VDZ in treating inflammatory bowel disease (IBD).DesignA nationwide, prospective multicentre extension of a Swedish observational study on VDZ assessing Effectiveness And Healthcare resource utilization in patients with IBD (SVEAH).MethodsAfter re-consent, data of patients with Crohn's disease (CD) (n = 68) and ulcerative colitis (UC) (n = 46) treated with VDZ were prospectively recorded using an electronic case report form integrated with the Swedish IBD Register (SWIBREG). The primary outcome was clinical remission (defined as Harvey-Bradshaw Index ⩽4 in CD and partial Mayo score ⩽2 in UC) at 104 and 156 weeks in patients with a response and/or remission 12 weeks after starting VDZ. Secondary outcomes included health-related quality of life (HRQoL) and biochemical outcomes.ResultsVDZ continuation rates were high at weeks 104 and 156, 88% and 84%, respectively, for CD and 87% and 78%, respectively, for UC. Of the 53 CD patients with a response/remission at 12 weeks, 40 (75%) patients were in remission at 104 weeks and 42 (79%) patients at 156 weeks. For UC, these numbers were 25/31 (81%) and 22/31 (71%), respectively. Improvements were seen in the Short Health Scale (p < 0.01 for each dimension; CD, n = 51; UC, n = 33) and the EuroQol 5-Dimensions, 5-levels index value (p < 0.01; CD, n = 39; UC, n = 30). Median plasma-C-reactive protein concentrations (mg/L) decreased from 5 at baseline to 4 in CD (p = 0.01, n = 53) and from 5 to 4 in UC (p = 0.03, n = 34) at 156 weeks. Correspondingly, median faecal-calprotectin (µg/g) decreased from 641 to 114 in CD patients (p < 0.01, n = 26) and from 387 to 37 in UC patients (p = 0.02, n = 17).ConclusionVDZ demonstrated high continuation rates and was associated with improvements in clinical outcomes, HRQoL measures and inflammatory markers at 2 and 3 years after treatment initiation in this prospective national SVEAH extension study.RegistrationENCePP registration number: EUPAS22735.

Project description:Background: Metabolic and bariatric surgery (MBS) is a well-established treatment for severe obesity, yet its effects in patients with inflammatory bowel disease (IBD) are not well understood. MBS in this population presents unique challenges, including the potential for exacerbating inflammatory disease activity and causing complications such as malnutrition and medication malabsorption. This study aims to assess the long-term outcomes of MBS in IBD patients, focusing on both metabolic outcomes and its impact on the course of IBD. Methods: A retrospective analysis was conducted on 20 patients with IBD who underwent MBS at a tertiary center between 2005 and 2019. Data on baseline characteristics, surgical procedures, complications, weight loss, resolution of obesity-related diseases, and IBD-related outcomes were collected. Results: The cohort, primarily female (65%), had a mean preoperative body mass index (BMI) of 40.8 kg/m2. The MBS procedures performed were sleeve gastrectomy (n = 9), Roux-en-Y gastric bypass (n = 6), one-anastomosis gastric bypass (n = 2), and Laparoscopic Adjustable Gastric Banding (n = 3). No major 30-day complications were recorded. At a median follow-up of 91 months, the mean BMI decreased by 9.5 kg/m2, with satisfactory outcomes in terms of resolution of obesity-related diseases. IBD activity scores increased postoperatively, particularly in Crohn's disease (CD) patients, although these changes were not statistically significant. In addition, 30% of patients were hospitalized due to IBD exacerbation, and 15% required surgical intervention for IBD. Conclusions: MBS is an effective treatment for severe obesity and its related diseases in IBD patients. While encountering no major complications or mortality, some long-term complications were observed, with a possible increase in IBD activity, particularly in CD patients. Ongoing challenges, such as the risk of malnutrition, medication malabsorption, and postoperative IBD exacerbations, necessitate careful long-term follow-up.

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Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases.

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Mode of childbirth and long-term outcomes in women with inflammatory bowel diseases.

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