Risk of Cesarean Delivery Among People with Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study

Andrea N Simpson; Rinku Sutradhar; Eric I Benchimol; Wing C Chan; Joan Porter; Sarah Moore; Fahima Dossa; Vivian Huang; Cynthia Maxwell; Laura Targownik; Ning Liu; Nancy N Baxter

doi:10.1016/j.jogc.2024.102463

Risk of Cesarean Delivery Among People with Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study

J Obstet Gynaecol Can. 2024 Apr 15:102463. doi: 10.1016/j.jogc.2024.102463. Online ahead of print.

Authors

Andrea N Simpson¹, Rinku Sutradhar², Eric I Benchimol³, Wing C Chan⁴, Joan Porter⁴, Sarah Moore⁵, Fahima Dossa⁶, Vivian Huang⁷, Cynthia Maxwell⁸, Laura Targownik⁷, Ning Liu², Nancy N Baxter⁹

Affiliations

¹ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: Andrea.Simpson@unityhealth.to.
² ICES, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁴ ICES, Toronto, ON, Canada.
⁵ Department of Surgery, MacKenzie Health, Vaughan, ON, Canada.
⁶ Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Department of Gastroenterology, Sinai Health System, Toronto, ON, Canada.
⁸ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁹ ICES, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

PMID: 38631434
DOI: 10.1016/j.jogc.2024.102463

Abstract

Objective: It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall and by disease characteristics, as well as time to subsequent delivery.

Methods: Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model.

Results: We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorized as having perianal disease (IBD-PA, n = 764, 10.2%), prior ileo-anal pouch anastomosis (IBD-IPAA, n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted OR 1.27, 95% CI 1.20-1.34). IBD-IPAA had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted HR 1.03, 95% CI 1-1.07).

Conclusion: The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.

Keywords: cesarean delivery; episiotomy; inflammatory bowel disease; mode of delivery; obstetrical anal sphincter injury (OASIS); operative vaginal delivery.