Diverticulitis in Pregnancy: A National Readmissions Database Study

Authors:
Alan Smith, Dayle Colpitts, Jessica Weaver

Body of Abstract:
Background
Current guidelines recommend employing standard procedural indications for the management of appendicitis and biliary disease in pregnant patients. Withholding the standard of care for these conditions based on pregnancy status alone is associated with an increase in maternal and fetal complications. There is a paucity of data however, regarding diverticular disease in obstetric patients, and there remains no formal management guidelines for this population. The incidence of diverticulitis in patients younger than 50 years old increased by 132% from 1980-2007. Furthermore, CDC data continues to demonstrate an upward trend in the mean age of pregnant individuals, with 19% of all pregnancies in the US occurring in women 35 years and older. National trends toward earlier onset diverticulitis combined with more advanced maternal age may converge, making diverticulitis an increasingly important etiology of obstetric abdominal infection. The purpose of this study was to identify the prevalence of diverticulitis is pregnant patients as well as the common complications associated with this disease process.

Methods
The National Readmissions Database (NRD) was queried for all visits in the first 3 quarters of each year 2016 to 2019, that included a patient with an ICD-10 code for diverticulitis and pregnancy. These entries were then further investigated for demographics, gestation, severity of disease, rates of intervention, readmissions, and pregnancy-related complications.

Results
470 patients were identified with a diagnosis of diverticulitis and pregnancy. Age at admission ranged from 17 to 52 years old with most patients presenting in the third decade (n=296, 62.9%). Most patients (n=340, 72.3%) were in the third trimester of pregnancy. 160/470 (34.0%) of admissions led to fetal delivery within 48 hours. 3.8% of patients (n=18) had complicated diverticulitis on index admission, with 8 patients undergoing diagnostic laparoscopy (1.7%), 2 exploratory laparotomy (0.4%), and ultimately 5 had colonic resection (1.1%). The 90-day readmission rate for perforation or abscess was 1.3%. There were no reported maternal deaths. The overall rate of fetal loss was 1.9%, and fetal complications was 2.3%. The most frequent complication events were abnormal fetal heart rate 20.8%, gestational diabetes 19.1%, hypertension 17.6%, fetal distress 5.3%, preterm labor 5.1%, hemorrhage 4.5%, and amniotic space infection 2.8%.

Conclusions
Diverticulitis can affect a broad range of pregnant patients and is not a benign condition. It should not be neglected in the differential workup for obstetric intraabdominal infections, especially given the population-level trends towards earlier onset of diverticular disease and advancing maternal age. Further investigation is warranted to better define the outcomes and guide best practices in this population.