Prior IBD Surgery Increases Risk of Ileus and Bowel Obstruction During Pregnancy: Study Finds

The study found that women with IBD who have undergone previous surgery are at an increased risk of developing ileus or bowel obstruction during pregnancy. The risk is notably higher in those with ulcerative colitis (UC) (adjusted odds ratio [aOR] 71.9) compared to those with Crohn’s disease (CD) (aOR 10.0). The risk is particularly elevated for UC patients who have permanent ileostomies (aOR 128.6) and for CD patients with intestinal surgery stomas (aOR 43.8), highlighting the importance of close monitoring in pregnant women with a history of IBD surgery.

Women with inflammatory bowel disease who undergo surgery before pregnancy are at an elevated risk for adverse maternal and fetal outcomes. Despite this, there has been limited research on the gastrointestinal complications these women may face during pregnancy. To fill this gap, Sonia Friedman, Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, USA, and colleagues aimed to examine the risks of gastrointestinal complications, specifically during pregnancy in this group.

For this purpose, the researchers used the Danish national registries to identify live-born children of mothers with ulcerative colitis or Crohn's disease who had undergone IBD surgery before pregnancy. They then compared the outcomes of ileus and bowel obstruction during pregnancy in women with UC or CD who had surgery to those who had not undergone surgery before pregnancy.

The key findings of the study were as follows:

• IBD surgery before pregnancy was more common in women with Crohn's disease (CD) than those with ulcerative colitis (UC), with 31.5% of women with CD having surgery compared to 6.3% of women with UC.
• Among live births, 7.1% of mothers with UC surgery and 1.8% of mothers with CD surgery were diagnosed with ileus or bowel obstruction during pregnancy.
• Women with UC who had surgery had an adjusted odds ratio (aOR) of 71.98 for ileus or bowel obstruction compared to those with UC who had not undergone surgery.
• For UC patients, those with permanent ileostomies had an aOR of 128.69, and those with ileoanal pouch anastomosis (IPAA) with diverting ostomy had an aOR of 40.14.
• Women with CD who had surgery had an aOR of 10.00 for ileus or bowel obstruction.
• For CD patients, those with intestinal surgery (no stoma) had an aOR of 7.96, and those with intestinal surgery (with stoma) had an aOR of 43.89.

"The findings highlight a significant risk of ileus and bowel obstruction during pregnancy in women who have undergone IBD surgery before conception. This emphasizes the importance of close monitoring and management for these patients during pregnancy to mitigate potential complications," the authors concluded.

Reference:

Friedman, Sonia1,2,3,a; Nielsen, Jan1,2,3; Andersen, Mette Louise2,3,4; Nørgård, Bente Mertz1,2,3. Complications of ileus and bowel obstruction during pregnancy in women who have had surgery for IBD: A population-based study. The American Journal of Gastroenterology ():10.14309/ajg.0000000000003425, March 24, 2025. | DOI: 10.14309/ajg.0000000000003425