Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015
Abstract Background Non-obstetric surgery conducted during pregnancy may increase the risk of adverse birth outcomes like small for gestational age, preterm birth, and miscarriage. Mechanisms are unclear but possibly longer lasting. We examined whether appendectomy, cholecystectomy and diagnostic la...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-020-2796-3 |
| _version_ | 1818665155374874624 |
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| author | Anne Staub Rasmussen Christian Fynbo Christiansen Niels Uldbjerg Mette Nørgaard |
| author_facet | Anne Staub Rasmussen Christian Fynbo Christiansen Niels Uldbjerg Mette Nørgaard |
| author_sort | Anne Staub Rasmussen |
| collection | DOAJ |
| description | Abstract Background Non-obstetric surgery conducted during pregnancy may increase the risk of adverse birth outcomes like small for gestational age, preterm birth, and miscarriage. Mechanisms are unclear but possibly longer lasting. We examined whether appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy affect these outcomes. Methods This nationwide Danish prevalence study included all pregnancies during 1996–2015 that had an appendectomy, cholecystectomy or diagnostic laparoscopy registered before last menstrual period in the years 1992–2015. We excluded pregnancies with surgery and categorized pre-pregnancy surgery according to timing (0–11, 12–23, and 24+ months before last menstrual period). Outcomes were small for gestational age, late preterm birth (32–37 weeks), early preterm birth (22–31 weeks) and miscarriage (7–21 weeks). We computed absolute risks and used logistic regression comparing pregnancies with surgery 0–11 or 12–23 to 24+ months before last menstrual period, computing odds ratios for each outcome, adjusting for maternal age and smoking. Results We identified 15,939 pregnancies with appendectomy, 12,869 pregnancies with cholecystectomy and 19,330 pregnancies with diagnostic laparoscopy. The absolute risk of small for gestational age was 2.2% for patients with appendectomy 0–11 months before last menstrual period, 3.2% 12–23 months before compared with 2.2% when appendectomy was conducted more than 24 months before (adjusted OR 0.95 (95% CI; 0.65 to 1.31) and 1.37(95% CI;1.00 to 1.86). For early preterm birth, the absolute risks were 0.7, 0.5 and 0.8%, for late preterm birth 4.8, 4.4 and 4.7% and for miscarriage 5.7, 6.2 and 5.4%.We observed similar results for cholecystectomy. For diagnostic laparoscopy 0–11 months before pregnancy we found increased risks of small for gestational age (4.0, 2.8 and 2.6%) and late preterm birth (5.9, 5.0 and 4.8%). Conclusions We found no increased risk of adverse birth outcomes among pregnancies with appendectomy or cholecystectomy conducted within 2 years before pregnancy compared to more than 2 years before pregnancy. The increased risks 0–11 months after diagnostic laparoscopy are likely explained by confounding by underlying indication. It appears safe to become pregnant any time following appendectomy and cholecystectomy, but, probably depending on indication, attention should be payed 0–11 months after diagnostic laparoscopy. |
| first_indexed | 2024-12-17T05:44:08Z |
| format | Article |
| id | doaj.art-dc79020651354192a2094ae291160e76 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-17T05:44:08Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-dc79020651354192a2094ae291160e762022-12-21T22:01:22ZengBMCBMC Pregnancy and Childbirth1471-23932020-02-012011810.1186/s12884-020-2796-3Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015Anne Staub Rasmussen0Christian Fynbo Christiansen1Niels Uldbjerg2Mette Nørgaard3Department of Clinical Epidemiology, Aarhus University HospitalDepartment of Clinical Epidemiology, Aarhus University HospitalDepartment of Obstetrics and Gynecology, Aarhus University HospitalDepartment of Clinical Epidemiology, Aarhus University HospitalAbstract Background Non-obstetric surgery conducted during pregnancy may increase the risk of adverse birth outcomes like small for gestational age, preterm birth, and miscarriage. Mechanisms are unclear but possibly longer lasting. We examined whether appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy affect these outcomes. Methods This nationwide Danish prevalence study included all pregnancies during 1996–2015 that had an appendectomy, cholecystectomy or diagnostic laparoscopy registered before last menstrual period in the years 1992–2015. We excluded pregnancies with surgery and categorized pre-pregnancy surgery according to timing (0–11, 12–23, and 24+ months before last menstrual period). Outcomes were small for gestational age, late preterm birth (32–37 weeks), early preterm birth (22–31 weeks) and miscarriage (7–21 weeks). We computed absolute risks and used logistic regression comparing pregnancies with surgery 0–11 or 12–23 to 24+ months before last menstrual period, computing odds ratios for each outcome, adjusting for maternal age and smoking. Results We identified 15,939 pregnancies with appendectomy, 12,869 pregnancies with cholecystectomy and 19,330 pregnancies with diagnostic laparoscopy. The absolute risk of small for gestational age was 2.2% for patients with appendectomy 0–11 months before last menstrual period, 3.2% 12–23 months before compared with 2.2% when appendectomy was conducted more than 24 months before (adjusted OR 0.95 (95% CI; 0.65 to 1.31) and 1.37(95% CI;1.00 to 1.86). For early preterm birth, the absolute risks were 0.7, 0.5 and 0.8%, for late preterm birth 4.8, 4.4 and 4.7% and for miscarriage 5.7, 6.2 and 5.4%.We observed similar results for cholecystectomy. For diagnostic laparoscopy 0–11 months before pregnancy we found increased risks of small for gestational age (4.0, 2.8 and 2.6%) and late preterm birth (5.9, 5.0 and 4.8%). Conclusions We found no increased risk of adverse birth outcomes among pregnancies with appendectomy or cholecystectomy conducted within 2 years before pregnancy compared to more than 2 years before pregnancy. The increased risks 0–11 months after diagnostic laparoscopy are likely explained by confounding by underlying indication. It appears safe to become pregnant any time following appendectomy and cholecystectomy, but, probably depending on indication, attention should be payed 0–11 months after diagnostic laparoscopy.https://doi.org/10.1186/s12884-020-2796-3PregnancySurgical procedures operativePrevalenceEpidemiologyAppendectomyDenmark |
| spellingShingle | Anne Staub Rasmussen Christian Fynbo Christiansen Niels Uldbjerg Mette Nørgaard Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 BMC Pregnancy and Childbirth Pregnancy Surgical procedures operative Prevalence Epidemiology Appendectomy Denmark |
| title | Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 |
| title_full | Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 |
| title_fullStr | Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 |
| title_full_unstemmed | Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 |
| title_short | Appendectomy, cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes: a nationwide registry-based prevalence study 1996–2015 |
| title_sort | appendectomy cholecystectomy and diagnostic laparoscopy conducted before pregnancy and risk of adverse birth outcomes a nationwide registry based prevalence study 1996 2015 |
| topic | Pregnancy Surgical procedures operative Prevalence Epidemiology Appendectomy Denmark |
| url | https://doi.org/10.1186/s12884-020-2796-3 |
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