Women with inflammatory bowel diseases less concerned about pregnancy

Last Updated: 2015-05-15

By Will Boggs MD

NEW YORK (Reuters Health) - Women with inflammatory bowel diseases (IBD) are less worried about pregnancy and reproductive planning than previously reported, according to a new phone survey.

Adverse pregnancy outcomes in women with IBD are associated with the level of disease activity at the time of conception, and most women with well-controlled IBD can be assured of similar pregnancy outcomes to women without IBD.

Despite this reassuring evidence, previous research has shown lower parity and higher rates of voluntary childlessness in women with IBD compared to the general population.

In light of improvements in the medical management of IBD with the addition of biological therapies over the past decade, Dr. Lori M. Gawron, from the University of Utah, Salt Lake City, and colleagues explored the current disease-related pregnancy concerns and their effect on parity and future reproductive planning through a phone survey of 129 women with IBD (77 with Crohn's disease, 52 with ulcerative colitis).

Half the women had at least one child, and 57% desired a future pregnancy, but 53% expressed disease-related concerns that affected decision-making regarding pregnancy.

More women desiring a future pregnancy (69.1%) than women who did not desire a future pregnancy (30.9%) were concerned about adverse pregnancy outcomes. They were most concerned about the effect of medications in pregnancy, the effect of pregnancy on disease activity, the heritability of the disease, and the potential of infertility.

Concerns regarding disease heritability were more common among women with Crohn's disease than among those with ulcerative colitis.

Among women who had completed their families, there was no significant difference in final parity between those who had IBD-related pregnancy concerns and those who did not, according to the April 22 Journal of Family Planning & Reproductive Health Care online report.

"The data support continued efforts to educate women with IBD on issues surrounding reproductive planning," the researchers concluded. "Mitigating perceived risks might allow for women to choose a family size based upon personal desire, rather than fear of adverse disease outcomes."

"Further research to assess best patient and provider educational interventions, as well as comparative studies across the spectrum of IBD severity, could inform clinical practice guidelines and minimize misperceptions regarding risk of pregnancy for women with IBD," they added.

Dr. Philip Hendy, from St. Mark's Hospital, Harrow, UK, recently reviewed reproductive health, pregnancy, and lactation in IBD. He told Reuters Health by email, "Over 50% of young patients with IBD still express concerns around pregnancy, and it is imperative that the physician offers IBD patients of child-bearing age the opportunity to discuss their plans around starting a family and their disease-related fears."

"This study demonstrated lower levels of voluntary reduction in intended family size as a result of IBD factors (4%) than previous studies (14%), but different endpoints were being evaluated (the entire IBD population in the former, the nulliparous population in the later)," Dr. Hendy explained. "It is also possible that in the decade since 'voluntary childlessness' in IBD was identified that greater physician awareness of the problem has led to improved counseling on the issues around pregnancy in IBD, leading to a better informed cohort of patients."

Dr. Janneke van der Woude, gastroenterologist from Erasmus MC Rotterdam, the Netherlands, coauthored The Second European Evidenced-Based Consensus on Reproduction and Pregnancy in Inflammatory Bowel Disease. She told Reuters Health by email, "It is not clear whether females had their first baby while also being diagnosed with IBD; also it is unclear if they had already IBD during an earlier pregnancy and their disease worsened. Because a lot of the previous history remains unclear in this paper, the results are really difficult to interpret."

"It is not the pregnancy that is the risk; the risk is a relapse of IBD during pregnancy, and therefore it is important that every female with IBD and an active pregnancy wish is counseled not only about general aspects of pregnancy but also on disease-related aspects," Dr. van der Woude said. "Most important for the disease-related aspects is remission during conception and pregnancy, because this is related to a favored outcome. Therefore, IBD females should be aware of maintaining their drugs during pregnancy, as most drugs with the exception of methotrexate are of low risk."

Rather than targeting IBD women for preconception counseling, she believes that such counseling "is necessary for every female with a pregnancy wish."

Dr. Gawron did not respond to a request for comments.

The National Institute of Child Health and Development funded this research. The authors reported no disclosures.

SOURCE: http://bmj.co/1EL5nnv

J Fam Plann Reprod Health Care 2015.