Does surgery prior to 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) have bowel surgery prior to pregnancy and there is little data on pregnancy outcomes in this population. We aimed to assess maternal/fetal outcomes in women with CD and UC surgeries prior to pregnancy. Methods In this nationwide study, we included all pregnancies in women with CD or UC from 1997-2022 and examined 6 categories of CD and UC surgeries prior to 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, versus did not, have surgery prior to 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 (aORs: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 prior to pregnancy.