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. 1999 Aug;45(2):218–222. doi: 10.1136/gut.45.2.218

Oral contraceptive use and the clinical course of Crohn's disease: a prospective cohort study

J Cosnes 1, F Carbonnel 1, F Carrat 1, L Beaugerie 1, J Gendre 1
PMCID: PMC1727605  PMID: 10403733

Abstract

BACKGROUND—Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease.
AIM—To assess the effect of oral contraceptive use on the clinical course of Crohn's disease.
PATIENTS—331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index <200, were enrolled consecutively during a one year period. Patients were classified at inclusion as oral contraceptive users or non-users and smokers or non-smokers.
METHODS—A prospective 12-18 month cohort study was used. The main outcome measures were flare up rate and time to flare up.
RESULTS—In total, 134 women used oral contraceptives, in most cases low oestrogen formulations. During the study period, 61 oral contraceptive users (46%) developed a flare up, compared with 85 non-users (43%). The hazard ratio for oral contraceptive use was 1.11 (95% confidence interval 0.80 to 1.55). Variables associated with flare up were smoking status, recently active disease, baseline Crohn's disease activity index, and presence of anoperineal lesions. The same results were obtained when the analysis was restricted to patients eligible for a relapse prevention trial.
CONCLUSION—Unlike smoking, oral contraceptives have no effect on Crohn's disease activity.


Keywords: Crohn's disease; smoking; oral contraceptives

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Figure 1  .

Figure 1  

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Kaplan-Meier life table analysis of the occurrence of a flare up episode of Crohn's disease in the study population, according to oral contraceptive (OC) use at baseline.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beller F. K., Ebert C. Effects of oral contraceptives on blood coagulation. A review. Obstet Gynecol Surv. 1985 Jul;40(7):425–436. doi: 10.1097/00006254-198507000-00003. [DOI] [PubMed] [Google Scholar]
  2. Best W. R., Becktel J. M., Singleton J. W. Rederived values of the eight coefficients of the Crohn's Disease Activity Index (CDAI). Gastroenterology. 1979 Oct;77(4 Pt 2):843–846. [PubMed] [Google Scholar]
  3. Boyko E. J., Theis M. K., Vaughan T. L., Nicol-Blades B. Increased risk of inflammatory bowel disease associated with oral contraceptive use. Am J Epidemiol. 1994 Aug 1;140(3):268–278. doi: 10.1093/oxfordjournals.aje.a117246. [DOI] [PubMed] [Google Scholar]
  4. Calkins B. M. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. 1989 Dec;34(12):1841–1854. doi: 10.1007/BF01536701. [DOI] [PubMed] [Google Scholar]
  5. Cosnes J., Carbonnel F., Beaugerie L., Le Quintrec Y., Gendre J. P. Effects of cigarette smoking on the long-term course of Crohn's disease. Gastroenterology. 1996 Feb;110(2):424–431. doi: 10.1053/gast.1996.v110.pm8566589. [DOI] [PubMed] [Google Scholar]
  6. Cottone M., Rosselli M., Orlando A., Oliva L., Puleo A., Cappello M., Traina M., Tonelli F., Pagliaro L. Smoking habits and recurrence in Crohn's disease. Gastroenterology. 1994 Mar;106(3):643–648. doi: 10.1016/0016-5085(94)90697-1. [DOI] [PubMed] [Google Scholar]
  7. Duffy L. C., Zielezny M. A., Marshall J. R., Weiser M. M., Byers T. E., Phillips J. F., Ogra P. L., Graham S. Cigarette smoking and risk of clinical relapse in patients with Crohn's disease. Am J Prev Med. 1990 May-Jun;6(3):161–166. [PubMed] [Google Scholar]
  8. Godet P. G., May G. R., Sutherland L. R. Meta-analysis of the role of oral contraceptive agents in inflammatory bowel disease. Gut. 1995 Nov;37(5):668–673. doi: 10.1136/gut.37.5.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hennekens C. H., MacMahon B. Oral contraceptives and myocardial infarction. N Engl J Med. 1977 May 19;296(20):1166–1167. doi: 10.1056/NEJM197705192962012. [DOI] [PubMed] [Google Scholar]
  10. Katschinski B., Fingerle D., Scherbaum B., Goebell H. Oral contraceptive use and cigarette smoking in Crohn's disease. Dig Dis Sci. 1993 Sep;38(9):1596–1600. doi: 10.1007/BF01303165. [DOI] [PubMed] [Google Scholar]
  11. Lashner B. A., Kane S. V., Hanauer S. B. Lack of association between oral contraceptive use and Crohn's disease: a community-based matched case-control study. Gastroenterology. 1989 Dec;97(6):1442–1447. doi: 10.1016/0016-5085(89)90388-0. [DOI] [PubMed] [Google Scholar]
  12. Lennard-Jones J. E. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–19. doi: 10.3109/00365528909091339. [DOI] [PubMed] [Google Scholar]
  13. Liebman H. A., Kashani N., Sutherland D., McGehee W., Kam A. L. The factor V Leiden mutation increases the risk of venous thrombosis in patients with inflammatory bowel disease. Gastroenterology. 1998 Oct;115(4):830–834. doi: 10.1016/s0016-5085(98)70253-7. [DOI] [PubMed] [Google Scholar]
  14. Lindberg E., Järnerot G., Huitfeldt B. Smoking in Crohn's disease: effect on localisation and clinical course. Gut. 1992 Jun;33(6):779–782. doi: 10.1136/gut.33.6.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Petitti D. B., Sidney S., Bernstein A., Wolf S., Quesenberry C., Ziel H. K. Stroke in users of low-dose oral contraceptives. N Engl J Med. 1996 Jul 4;335(1):8–15. doi: 10.1056/NEJM199607043350102. [DOI] [PubMed] [Google Scholar]
  16. Poller L. Oral contraceptives, blood clotting and thrombosis. Br Med Bull. 1978 May;34(2):151–156. doi: 10.1093/oxfordjournals.bmb.a071485. [DOI] [PubMed] [Google Scholar]
  17. Sandler R. S., Wurzelmann J. I., Lyles C. M. Oral contraceptive use and the risk of inflammatory bowel disease. Epidemiology. 1992 Jul;3(4):374–378. doi: 10.1097/00001648-199207000-00014. [DOI] [PubMed] [Google Scholar]
  18. Sutherland L. R., Ramcharan S., Bryant H., Fick G. Effect of cigarette smoking on recurrence of Crohn's disease. Gastroenterology. 1990 May;98(5 Pt 1):1123–1128. doi: 10.1016/0016-5085(90)90324-t. [DOI] [PubMed] [Google Scholar]
  19. Sutherland L. R., Ramcharan S., Bryant H., Fick G. Effect of oral contraceptive use on reoperation following surgery for Crohn's disease. Dig Dis Sci. 1992 Sep;37(9):1377–1382. doi: 10.1007/BF01296007. [DOI] [PubMed] [Google Scholar]
  20. Talbot R. W., Heppell J., Dozois R. R., Beart R. W., Jr Vascular complications of inflammatory bowel disease. Mayo Clin Proc. 1986 Feb;61(2):140–145. doi: 10.1016/s0025-6196(12)65200-8. [DOI] [PubMed] [Google Scholar]
  21. Thompson N. P., Wakefield A. J., Pounder R. E. Inherited disorders of coagulation appear to protect against inflammatory bowel disease. Gastroenterology. 1995 Apr;108(4):1011–1015. doi: 10.1016/0016-5085(95)90197-3. [DOI] [PubMed] [Google Scholar]
  22. Timmer A., Sutherland L. R., Martin F. Oral contraceptive use and smoking are risk factors for relapse in Crohn's disease. The Canadian Mesalamine for Remission of Crohn's Disease Study Group. Gastroenterology. 1998 Jun;114(6):1143–1150. doi: 10.1016/s0016-5085(98)70419-6. [DOI] [PubMed] [Google Scholar]
  23. Wakefield A. J., Sawyerr A. M., Dhillon A. P., Pittilo R. M., Rowles P. M., Lewis A. A., Pounder R. E. Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet. 1989 Nov 4;2(8671):1057–1062. doi: 10.1016/s0140-6736(89)91078-7. [DOI] [PubMed] [Google Scholar]
  24. Wakefield A. J., Sawyerr A. M., Hudson M., Dhillon A. P., Pounder R. E. Smoking, the oral contraceptive pill, and Crohn's disease. Dig Dis Sci. 1991 Aug;36(8):1147–1150. doi: 10.1007/BF01297463. [DOI] [PubMed] [Google Scholar]
  25. Wright J. P. Factors influencing first relapse in patients with Crohn's disease. J Clin Gastroenterol. 1992 Jul;15(1):12–16. doi: 10.1097/00004836-199207000-00005. [DOI] [PubMed] [Google Scholar]

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