Prior CD-related abdominal surgery has no bearing on pregnancy outcomes

In expectant mothers, a history of abdominal surgery for Crohn’s disease (CD) exerts no adverse effect on pregnancy, neonatal, or wound healing outcomes, according to the prospective PIANO study.

In a cohort of pregnant women with CD, rates of c-section were similar between those who did have history of CD-related abdominal surgery and those who did not (28 percent vs 23 percent; p=0.054). [AIBD 2025, abstract 81]

However, women with prior abdominal surgery were more likely to have elective c-sections (16 percent vs 11 percent; p=0.018) and undergo c-section due to active IBD specifically (11 percent vs 7 percent; p=0.016), the authors pointed out.

Preterm birth (<37 weeks) occurred with significantly greater frequency among women with vs without prior abdominal surgery (9 percent vs 5 percent; p=0.029). There were no significant between-group differences in other outcomes such as small for gestational age, neonatal intensive care unit (NICU) admission, infant Apgar scores, and maternal wound infections associated with c-section or vaginal delivery.

In multivariate analysis, predictors of preterm birth included disease activity (odds ratio [OR], 1.14, 95 percent confidence interval [CI], 1.06–1.22) and ileal disease location (OR, 2.19, 95 percent CI, 1.26–3.83). Prior CD surgery did not modify the odds of preterm birth.

The findings provide reassuring evidence that prior CD-related abdominal surgery does not adversely affect pregnancy outcomes, the authors said. This has important implications given that “a substantial proportion undergo surgery within 10 years of diagnosis, despite advances in medical therapy.”

PIANO cohort

PIANO involved 1,046 women with CD who had singleton pregnancies. Of these women, 409 (39 percent) had a history of CD-related abdominal surgery. Women who had prior abdominal surgery were older (32.3 vs 31.7 years), had lower BMI (23.7 vs 24.2 kg/m²), higher disease activity (p<0.001), and longer disease duration (11.9 vs 8.9 years; p<0.001) compared with those who had no prior surgery.

Disease location was more often ileal in the group of women with a history of abdominal surgery, with higher rates of upper tract and perianal disease relative to those who had no prior surgery (p<0.001). Use of advanced therapy did not differ between the two groups. Most of the women who had a history of abdominal surgery underwent ileocolic or small bowel resections (62 percent).

Data on demographics and disease, pregnancy and neonatal outcomes, and wound complications were collected using questionnaires administered during pregnancy and postpartum. Disease activity was measured via the Harvey Bradshaw Index.