Surgical endoscopy · 2026
Association between pregnancy and delivery mode and long-term pouch function in women with prior ileal pouch-anal anastomosis: a systematic review and meta-analysis.
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Lopez Christopher, Sipe Samantha, Abraham Abel, Burns James, Perrone Cameron, Wignakumar Anjelli, Wexner Steven D, Emile Sameh Hany
Аннотация
INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the association between pregnancy and delivery mode and long-term pouch function after ileal pouch-anal anastomosis (IPAA).
METHODS: A systematic review (CRD420251076660) was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, Cochrane Library, and Google Scholar were searched through June 2025 for studies reporting pouch-related outcomes among women with prior IPAA who became pregnant. Outcomes included continence, stool frequency, urgency, pouchitis, and pouch failure. Random-effects meta-analysis was performed to generate pooled estimates, with narrative synthesis where appropriate.
RESULTS: Eight studies, including 1350 women who had previously undergone IPAA, were evaluated. The median age was 32 years, and the mean follow-up after delivery was 79.2 months. Proportional meta-analysis of pouch function during pregnancy demonstrated a pooled incontinence and pad usage rates of 39.4% (95% CI 25-53%) and 21.8% (95 %CI 16.5-27%), respectively. Pouchitis during pregnancy was reported in 8% (95% CI 2-30%) of patients, while pouch outlet obstruction occurred in 10.9% (95% CI 2-20%). Pairwise meta-analysis demonstrated increased risk of incontinence after pregnancy (OR = 1.61, 95% CI 1.09; 2.38, p = 0.017), with non-significant changes in either daytime stool frequency (WMD = 0.56, 95% CI 0.19; 1.12, p= 0.358, I2 = 73%) or nocturnal (WMD = 0.17, 95% CI - 0.43; 0.78, p = 0.575, I2 = 77%), respectively. Cesarean section was associated with a significant reduction in nighttime bowel movements (WMD: -0.22, 95% CI: -0.41, -0.02, p=0.028), with no significant differences in other outcomes.
CONCLUSIONS: Pouch function remains largely stable during and after pregnancy, although fecal incontinence is common and may worsen postpartum. Mode of delivery does not meaningfully impact long-term pouch outcomes, supporting individualized, preference-sensitive decision-making. Heterogeneity in outcome reporting and the predominance of older studies highlight the need for contemporary research.
METHODS: A systematic review (CRD420251076660) was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, Cochrane Library, and Google Scholar were searched through June 2025 for studies reporting pouch-related outcomes among women with prior IPAA who became pregnant. Outcomes included continence, stool frequency, urgency, pouchitis, and pouch failure. Random-effects meta-analysis was performed to generate pooled estimates, with narrative synthesis where appropriate.
RESULTS: Eight studies, including 1350 women who had previously undergone IPAA, were evaluated. The median age was 32 years, and the mean follow-up after delivery was 79.2 months. Proportional meta-analysis of pouch function during pregnancy demonstrated a pooled incontinence and pad usage rates of 39.4% (95% CI 25-53%) and 21.8% (95 %CI 16.5-27%), respectively. Pouchitis during pregnancy was reported in 8% (95% CI 2-30%) of patients, while pouch outlet obstruction occurred in 10.9% (95% CI 2-20%). Pairwise meta-analysis demonstrated increased risk of incontinence after pregnancy (OR = 1.61, 95% CI 1.09; 2.38, p = 0.017), with non-significant changes in either daytime stool frequency (WMD = 0.56, 95% CI 0.19; 1.12, p= 0.358, I2 = 73%) or nocturnal (WMD = 0.17, 95% CI - 0.43; 0.78, p = 0.575, I2 = 77%), respectively. Cesarean section was associated with a significant reduction in nighttime bowel movements (WMD: -0.22, 95% CI: -0.41, -0.02, p=0.028), with no significant differences in other outcomes.
CONCLUSIONS: Pouch function remains largely stable during and after pregnancy, although fecal incontinence is common and may worsen postpartum. Mode of delivery does not meaningfully impact long-term pouch outcomes, supporting individualized, preference-sensitive decision-making. Heterogeneity in outcome reporting and the predominance of older studies highlight the need for contemporary research.