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

BackgroundThe 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 methodsInternational 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).ResultsOf 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).ConclusionsPregnancy in women with Crohn disease is a significant risk factor for Crohn-related surgical disease, in particular, anorectal suppuration and intestinal–genitourinary fistulas.