Title: The Mode of Delivery Does Not Influence the Severity of Post-Partum Perianal Disease
in Patients with Inflammatory Bowel Disease
Version: 3 Date: 10 Aug 2023
Reviewer's report:
This is a nicely written retrospective cohort study, including all consecutive female patients with
IBD who delivered either vaginally or by C-section between 1997-2022. The goal of the study
was to analyze if the mode of delivery impacted post-partum peri-anal disease in patients with
IBD. The authors concluded that previous abdominal surgery for IBD, ileocolonic involvement,
previous perianal disease, quiescent or active perianal disease at time of delivery or antibiotics
increased the risk of a perianal post-partum flare. The number of post-partum flares was higher
in the C-section group.
Major comments:
• Please clarify how do you distinguish between inactive perianal disease and quiescent. And
also, why do you consider quiescente or active perianal disease in the same group? Shouldn’t
it be separated?
• 6% of the patients experienced a postpartum perianal disease flare within 2 years after delivery.
Can you comment on how many patients had the disease flare in the first 6 weeks after delivery?
Can you comment if the risk is higher near the post-partum or after some months?
• Patients exposed to biologics had an increased risk of perianal disease flare. Do you have any
information regarding if these patients stopped biologics during pregnancy? If yes for how long?
• Antibiotics were associated with increased risk of post-partum flare. Which antibiotics were
these? Related to IBD or partum related? When were theses antibiotics prescribed?
Title: The Mode of Delivery Does Not Influence the Severity of Post-Partum Perianal Disease
in Patients with Inflammatory Bowel Disease
Version: 3 Date: 10 Aug 2023
Reviewer's report:
This is a nicely written retrospective cohort study, including all consecutive female patients with
IBD who delivered either vaginally or by C-section between 1997-2022. The goal of the study
was to analyze if the mode of delivery impacted post-partum peri-anal disease in patients with
IBD. The authors concluded that previous abdominal surgery for IBD, ileocolonic involvement,
previous perianal disease, quiescent or active perianal disease at time of delivery or antibiotics
increased the risk of a perianal post-partum flare. The number of post-partum flares was higher
in the C-section group.
Major comments:
• Please clarify how do you distinguish between inactive perianal disease and quiescent. And
also, why do you consider quiescente or active perianal disease in the same group? Shouldn’t
it be separated?
• 6% of the patients experienced a postpartum perianal disease flare within 2 years after delivery.
Can you comment on how many patients had the disease flare in the first 6 weeks after delivery?
Can you comment if the risk is higher near the post-partum or after some months?
• Patients exposed to biologics had an increased risk of perianal disease flare. Do you have any
information regarding if these patients stopped biologics during pregnancy? If yes for how long?
• Antibiotics were associated with increased risk of post-partum flare. Which antibiotics were
these? Related to IBD or partum related? When were theses antibiotics prescribed?
Please review this paper.
user
Title: The Mode of Delivery Does Not Influence the Severity of Post-Partum Perianal Disease
in Patients with Inflammatory Bowel Disease
Version: 3 Date: 10 Aug 2023
Reviewer's report:
This is a nicely written retrospective cohort study, including all consecutive female patients with
IBD who delivered either vaginally or by C-section between 1997-2022. The goal of the study
was to analyze if the mode of delivery impacted post-partum peri-anal disease in patients with
IBD. The authors concluded that previous abdominal surgery for IBD, ileocolonic involvement,
previous perianal disease, quiescent or active perianal disease at time of delivery or antibiotics
increased the risk of a perianal post-partum flare. The number of post-partum flares was higher
in the C-section group.
Major comments:
• Please clarify how do you distinguish between inactive perianal disease and quiescent. And
also, why do you consider quiescente or active perianal disease in the same group? Shouldn’t
it be separated?
• 6% of the patients experienced a postpartum perianal disease flare within 2 years after delivery.
Can you comment on how many patients had the disease flare in the first 6 weeks after delivery?
Can you comment if the risk is higher near the post-partum or after some months?
• Patients exposed to biologics had an increased risk of perianal disease flare. Do you have any
information regarding if these patients stopped biologics during pregnancy? If yes for how long?
• Antibiotics were associated with increased risk of post-partum flare. Which antibiotics were
these? Related to IBD or partum related? When were theses antibiotics prescribed?
assistant