Inflamm Bowel Dis. 2021 Aug 19;27(9):1418-1426. doi: 10.1093/ibd/izaa290

Taylor Geisman ¹, Ling Chen ², Margaret Rosanna Gray-Swain ³, Deborah Hiatt-Jensen ⁴, Alexandra Gutierrez ⁴

Author information

• ¹Division of General Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
• ²Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
• ³Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
• ⁴Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

Abstract

Background: Variable data have suggested that pregnant women with inflammatory bowel diseases (IBD) are more likely to have cesarean deliveries and adverse pregnancy outcomes than the general population. The aim of this study was to describe the rates of cesarean delivery and adverse pregnancy outcomes among patients with IBD as compared with patients with other autoimmune diseases and with the general population.

Methods: Pregnant patients with IBD, those with non-IBD autoimmune diseases, and control patients were identified. Baseline demographics, disease characteristics, medication use, and delivery outcomes were recorded in a retrospective manner. The primary outcome was overall rate of cesarean delivery; secondary outcomes included rates of planned and unplanned cesarean delivery, delivery complications, preterm delivery, and fetal complications.

Results: Ninety-three women with IBD were age-matched to 376 control patients; 38 women with other autoimmune diseases were also identified. Women with IBD had higher rates of cesarean delivery (47%) when compared with control patients (31%; P < 0.0001) but not when compared with women with other autoimmune diseases. There were high rates of planned cesarean deliveries for IBD-related factors in the IBD cohort. Women with IBD did not have increased rates of adverse delivery or fetal outcomes.

Conclusions: Women with IBD have higher rates of cesarean delivery than the general population and rates similar to those of women with other autoimmune diseases. Planned cesarean delivery plays an important role in maintaining continuity and sphincter control in select situations, but a diagnosis of IBD does not mandate cesarean delivery.