P226. Long-term impact of both deliveries and Crohn's disease on anoperineal lesions
A. Grouin1, L. Siproudhis2, J. Leveque1, J.-F. Bretagne2, P. Poulain1, G. Bouguen2, 1CHU Pontchaillou, Service de Gynécologie-Obstétrique, Rennes, France, 2CHU Pontchaillou, Service des Maladies de l'Appareil Digestif, Rennes, France
Despite a high prevalence of Crohn's disease in young women of childbearing age, individual factors including perianal Crohn's disease (PCD) on the fertility and issue of delivery on the natural history of PCD remains unclear.
Self-administered questionnaires were sent by mail to 329 consecutive patients of childbearing age who were seen for Crohn's disease between 2000 and 2010 at an academic hospital in France. The cumulative probabilities and associated factors of delivery and the occurrence of PCD after delivery were estimated using survival analysis.
The response rate of questionnaires was 64% (185 patients) including 63 nulliparous women. The probability of having a delivery was 30%, 51% and 72% at the age of 25, 30 and 35, respectively. Women with a known diagnosis of Crohn's disease at the time of childbearing age (HR = 6.58, 95% CI [3.5 to 13.1], p < 0.001) and women with a history of anal abscesses (HR = 4.8, 95% CI [1.2 to 21], p = 0.03) were less likely to have been pregnant. In 122 women who underwent at least one delivery (total 240 deliveries), 25 women (20%) had a history of PCD before their first pregnancy. Seventy-four (61%) patients had at least one vaginal delivery requiring 38 (44%) episiotomies. After a median follow-up of 126 months after delivery [6–438], 46 patients (38%) developed PCD including 20 patients within the first two years. The cumulative probabilities of occurrence of PCD were 7.8% and 22.2% at 1 and 5 years since the last delivery respectively. Episiotomy, instrumental delivery, and vaginal tears were not associated with ocurrence of PCD since the last delivery. Independent predictors of PCD after delivery were a history of PCD before pregnancy (HR = 17.7 [2.3 to 139], p = 0.006), anal fistula (HR = 9.8 [1, 3–97], p = 0.02), relapse of CD during pregnancy (HR = 5.9 [2.4 to 13], p = 0.0002), and cesarean section (HR = 3.5 [9.6 to 85], p = 0.03).
In this large series of patients, history of PCD is associated with fewer pregnancies and obstetric events did not affect the occurrence of perianal lesions at 1 and 5 years following delivery, which seem to be more influenced by the natural history of Crohn's disease itself.