Influence of medical treatment, smoking and disease activity on pregnancy outcomes in Crohn's disease.

OBJECTIVE. Little is known about predictors for adverse pregnancy outcomes among women with Crohn's disease (CD). In this population-based study, we examined pregnancy outcomes in CD stratified by medical treatment and smoking status while accounting for disease activity. METHODS. In two Danish regions with a population of 1.6 million, we identified 154 CD women who had given birth within a 6-year period. We combined questionnaire data, prescription data, data from medical records and population-based medical databases. We used logistic regression to estimate prevalence odds ratios (POR) for adverse pregnancy outcomes by different predictors. RESULTS. Among 105 (80%) respondents, 55 (52%) reported taking medication during pregnancy. The majority (95%) were in disease remission. The children's mean birth weight did not differ by maternal medical treatment. As expected, smoking was a predictor of low birth weight. Mean birth weight in children of smokers in medical treatment was significantly reduced by 274 g compared with children of non-smokers who received medical treatment. In children of women without medical treatment, this difference was 126 g between smokers and non-smokers. Women in medical treatment did not have an increased risk of preterm delivery (POR 0.71; 95% confidence interval (CI) 0.18-2.79), congenital malformations (POR 0.60; 0.10-3.76) or cesarean section (POR 1.40; 0.63-3.08). CONCLUSIon. In CD, smoking was negatively associated with child birth weight. This association was most pronounced among women who received medical treatment. Maternal medical treatment for CD did not seem to be a risk factor for adverse pregnancy outcomes.

Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn's disease.

OBJECTIVES: Adherence to medical treatment among women with Crohn's disease (CD) in the postpartum period has never been examined. The impact of breast-feeding on disease activity remains controversial. We aimed to assess rates of non-adherence to medical treatment among women with CD in the postpartum period. Further, to assess breast-feeding rates and the impact of breast-feeding on the risk of relapse. METHODS: Within a population of 1.6 million, we identified 154 women with CD who had given birth within a 6-year period. We combined questionnaire data, data from medical records and public register data. We used logistic regression to estimate prevalence odds ratios (POR) for non-adherence, relapse and breast-feeding according to different predictors. RESULTS: Among 105 (80%) respondents, 59 (56%) reported taking medication. Of these, 66.1% reported to be adherent to medical treatment. Fear of medication transmission to the breast milk was stated as the reason for non-adherence in 60%. Those who received counselling regarding medical treatment were less likely to be non-adherent (POR 0.55, 95% confidence interval [CI] 0.1-2.5). In total, 87.6% were breast-feeding. Breast-feeding rates did not vary by medical treatment. Predictors for relapse in CD were smoking (POR 1.85, 95% CI 0.62-5.54) and non-adherence among medical treated (POR 1.25, 95% CI 0.26-6.00). Breast-feeding seemed protective against relapse (POR 0.33, 95% CI 0.10-1.26). CONCLUSIONS: Adherence to medical treatment in the postpartum period was high, and counselling seemed to increase adherence. Relapse may be explained by non-adherence or smoking while breast-feeding seemed protective.

Early dynamic versus late static lymphoscintigraphy for the identification of sentinel lymph nodes in breast cancer.

PURPOSE: Sentinel lymph node (SLN) biopsy is an established method for the identification of early breast cancer metastases. SLN lymphoscintigraphy is pivotal in many cases, but the diagnostic value of early dynamic versus late static imaging procedures remains unclear. The objective of this study was to evaluate the diagnostic value of early dynamic versus late static imaging in the identification of SLN in breast cancer patients. MATERIALS AND METHODS: A total of 104 consecutive female patients who were referred for SLN scintigraphy prior to breast cancer surgery were included in this retrospective study. All patients underwent both a 20-minute dynamic lymphoscintigraphy and a 2-hour static acquisition. The images were independently evaluated for the presence, location, and numbers of SLN and echelon nodes in a blinded and random manner by 2 trained observers. Any discrepancy was solved by a third party arbitrator. RESULTS: SLN was identified in 101 of 104 (97%) patients on the static images versus 41 of 104 (39%) of the patients based on the dynamic acquisition. The combined use of dynamic and static images did not increase the diagnostic performance versus late lymphoscintigraphy alone. CONCLUSIONS: Identification of SLN by lymphoscintigraphy in breast cancer can be performed using a 2-hour static image alone.