Perianal Crohn's disease results in fewer pregnancies but is not exacerbated by vaginal delivery

Background: Despite a high prevalence of Crohn's disease in women of childbearing age, disease-related factors that may impact fertility and perianal Crohn's disease after delivery remain unclear. Methods: Self-administered questionnaires related to childbirth were completed by women with Crohn's disease referred to a single gastroenterology unit. A survival analysis was performed for statistical purposes. Results: A total of 184 patients were assessed, including 63 nulliparous women. The cumulative probabilities of having a child were 30%, 51% and 72% at the ages of 25, 30 and 35 years, respectively. Women with colonic disease, prior abdominal surgery and perianal disease were less likely to experience childbirth. After a median follow-up of 165 weeks post-delivery, the cumulative probabilities of fistulizing perianal Crohn's disease occurrence were 8%, 12% and 21% at 1, 2 and 5 years following childbirth, respectively. Contrary to a prior history of perianal Crohn's disease and colonic location, mode of delivery was not associated with perianal fistula. An episiotomy in the group of women with prior anal lesions did not result in a higher rate of fistula recurrence. Conclusion: Perianal Crohn's disease is associated with fewer pregnancies, however perianal fistulas were less affected by obstetric events than their own natural history. (c) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.