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Let’s review the results from a recently published study (systematic meta-analysis) that reviewed 27 different studies on the risk and incidence of postpartum flares in patients with Crohn's disease and ulcerative colitis. This study pooled the results from 27 different studies including 3,825 women. Here’s what they found:
How common are flares after childbirth in Crohn’s/colitis?
This study found that 29.5% of women with ulcerative colitis and 34.5% of women with Crohn’s disease experienced flares after giving birth.
Does stricturing or penetrating Crohn’s increase risk for postpartum flares?
- Those with stricturing Crohn’s were found to be about 3.5 times more likely to flare postpartum than those without stricturing Crohn’s.
- Those with penetrating Crohn’s were found to be 4.25 times more likely to flare after childbirth than those without penetrating Crohn’s.
Does the type of delivery impact disease activity?
- Those with vaginal delivery had a decreased risk for postpartum disease activity.
- Women with perianal Crohn’s disease with c-sections were 2.3 times more likely to flare postpartum compared with those who had vaginal delivery.
Does being in a flare at the time of conception increase the risk for flares postpartum?
According to the study, yes, woman in flares at the time of conception were 10.6 times more likely to flare postpartum compared to those in remission at the time of conception.
Does being in a flare during pregnancy increase the risk of flares after giving birth?
According to the study, yes, woman in flares while pregnant were 4.9 times more likely to flare postpartum compared to those in remission during pregnancy.
How do medications used during pregnancy affect the risk of postpartum flares?
- Women on thiopurines during pregnancy had a significantly decreased risk of postpartum flares.
- Women who discontinued their biologic before or during the third trimester were 1.8 times more likely to flare postpartum.
- Women who discontinued, delayed the restart of their biologic, or de-escalated their therapy after delivery were 7.4 times more likely to flare postpartum compared to women who resumed therapy after delivery.
- Malhi G, Tandon P, Perlmutter JW, Nguyen G, Huang V. Risk Factors for Postpartum Disease Activity in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2022;28(7):1090-1099.