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Women with IBD expect their gastroenterologist to initiate discussion of reproductive health

Crohn's & Colitis 360
Reuters Health - 25/01/2022 - Women with inflammatory bowel disease (IBD) often worry about their reproductive health and they expect their gastroenterologist to initiate this conversation, according to a new qualitative study. 

"I think these results highlight the importance of pediatric gastroenterologists and primary-care providers comprehensively addressing reproductive health with every person with IBD," Dr. Traci Kazmerski of the University of Pittsburgh Medical Center (UPMC), in Pennsylvania, told Reuters Health by email. 

She and her colleagues recruited 21 women with IBD for interviews covering their history and perspectives on pregnancy, contraception and family-planning care. 

The participants, who were patients at the UPMC Children's Hospital of Pittsburgh Inflammatory Bowel Disease Center and the Digestive Disorders Center at UPMC Shadyside, had an average age of 14 years when they were diagnosed with IBD (range, 12 to 16 years). 

As the researchers in their paper, published in Crohn's & Colitis 360, focusing on this age range made sure participants had made "the majority of their reproductive health decisions with their IBD in mind." The criterion also allowed the researchers to compare patient relationships between both adult and pediatric providers regarding IBD and reproductive-health concerns. 

Most of the study participants were white, with only one Black and one Latina interview subject. At the time of the study, the women's mean age was 25 years, with a range of 18 to 43; five had been pregnant in the past and 16 voiced a desire to have children someday; 15 of the women were being treated for Crohn's disease, while six others had ulcerative colitis; 13 were currently using some form of contraception; and six women were taking multiple medications for their IBD, with 12 taking biologics, eight taking 5-aminosalicylate, and five using an immunomodulator. 

Interviews were conducted until the researchers could identify common themes and reach a participant volume past which no new themes emerged. Two independent coders analyzed interview transcripts to identify key themes, of which four emerged. 

First, women with IBD who had never been pregnant appeared to lack reproductive-health knowledge, with six participants reporting themselves unaware of IBD's impact on fertility, pregnancy, or other related issues. Second, many of the women interviewed lacked clarity on the role IBD might play in their choice of contraceptives, with multiple participants reporting that they had not been properly counseled on available contraceptive options with their IBD in mind. 

Third, multiple women interviewed expressed concern about the heredity of their IBD, the risks of disease activity pre-childbirth, and the impact of their current medications on a future pregnancy. 

Last, many said they expected their gastroenterologist to initiate any relevant reproductive-health discussions with them related to their IBD diagnosis. The success and timeliness of these patient-provider discussions, the researchers stress, "may be a major determinant in not only the decision, but also the ability, of these women to become pregnant." 

While the authors acknowledge that their conclusions would benefit from a larger pool of interview subjects, greater geographic diversity, and parallel interviews with gastroenterologists and reproductive health providers, their findings are in line with past research. 

"Many patients are worried about taking medications preconception and in pregnancy," said Dr. Vivian Huang, the director of the Preconception and Pregnancy in IBD clinical research program at Mount Sinai Hospital in Toronto, Canada, who was not involved in the study. 

"They may not realize that active IBD is more harmful to pregnancy (increased risk of miscarriage, preterm birth, small for gestational age infants) than taking maintenance IBD medications (with exception of certain medications such as methotrexate or tofacitinib)," she told Reuters Health by email. 

Dr. Huang expressed hope that future research might specifically survey women who are "voluntarily childless" or who have chosen not to have children due to potential misperceptions about the impact that their IBD diagnosis and medications might have on reproductive health. 

SOURCE: https://bit.ly/3fIDOrv Crohn's & Colitis 360, online December 29, 2021. 

By Matthew Phelan 

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