Sa1828 INCIDENCE AND PREDICTORS OF FLARE IN THE POST PARTUM YEAR AMONG WOMEN WITH INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 158 (6) ◽  
pp. S-442
Author(s):  
Amy Yu ◽  
Sonia Friedman ◽  
Ashwin Ananthakrishnan
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Post Partum ◽  
Inflammatory Bowel

scholarly journals P058 The lived experience of family planning of female patients diagnosed with inflammatory bowel disease and their partners during key reproductive stages: a qualitative study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
W Czuber-Dochan ◽  
R Homer ◽  
M Brookes ◽  
C Selinger ◽  
S Purewal ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Family Planning ◽  
Lived Experience ◽  
Bowel Disease ◽  
Normal Population ◽  
Post Partum ◽  
Geographic Location ◽  
Sources Of Information ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD) is a chronic illness affecting patients in their childbearing years. The physical effects of IBD on fertility and pregnancy in IBD in remission (e.g. disease is well controlled during conception and throughout pregnancy) are similar to the normal population. However, many women with IBD have high pregnancy-related anxieties and are more likely not to have children compared with women without IBD. The reasons cited for not having children include high levels of pregnancy-related anxieties have been insufficiently explored. The study aimed to explore the lived experience of family planning of women with inflammatory bowel disease (IBD) and their partners with or without IBD, during the reproductive stages of pre-conception, pregnancy and the postnatal period. Methods Descriptive phenomenology was used to conduct face-to-face in-depth individual interviews. Purposive sampling was used to select participants with a maximum variation of different demographic and clinical factors, e.g. age, sex, UC/CD diagnosis, disease duration, surgery and geographic location. The NVivo 12 software programme was used to manage the data and Colaizzi’s framework was utilised in thematic data analysis. Results Twenty-four participants (21 women 11CD/10UC and three partners) were recruited from out-patient clinics (22 participants) or through the Crohn’s and Colitis UK website (two participants). Women, average age 31 years old (range 27–38), were at different family planning stages: pre-conception six women (three actively planning family and three voluntarily childless); pregnant eight women and two partners; and postpartum seven women and one partner. Three women’s partners, age 32–39, were recruited allowing for additional perspective of the experience being captured. In total, 19 h of interviews data were collected. Six themes were identified: (1) being diagnosed and controlling IBD symptoms, (2) relationship and family planning, (3) sources of information, (4) worries and concerns about pregnancy, (5) post pregnancy care and problems and (6) ways of improving care. Women in pre-pregnancy stage and pregnant expressed a need for more information around these themes: (1) their medication and the impact of IBD on the baby, (2) the genetic risk of passing the disease on. While pregnant and during post-partum stage, women identified a greater need for practical advice and support in relation to breastfeeding and looking after the baby. Conclusion Information specific to family planning stages need to be provided, to help women and their partners make the informed decision about family planning. Those who decided not to go down the family route also expressed a need for counselling and support.

Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study

Gut ◽  
2019 ◽  
Vol 68 (9) ◽  
pp. 1597-1605 ◽  
Author(s):  
Simone N Vigod ◽  
Paul Kurdyak ◽  
Hilary K Brown ◽  
Geoffrey C Nguyen ◽  
Laura E Targownik ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Mental Illness ◽  
Cohort Study ◽  
Bowel Disease ◽  
Post Partum ◽  
Population Based ◽  
Incidence Rates ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
New Onset

ObjectivePatients with inflammatory bowel disease (IBD) have an elevated risk of mental illness. We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and post partum.DesignThis cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.ResultsAbout 22.7% of women with IBD had new-onset mental illness versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care and infant mortality.ConclusionWomen with IBD were at an increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.

scholarly journals N11 Pregnancy Outcomes in Patients with inflammatory bowel disease: A single-centre experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S662-S662
Author(s):  
Y BAILEY ◽  
C Hanna ◽  
A O’Connor ◽  
N Breslin ◽  
B Ryan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pregnancy Outcomes ◽  
Congenital Abnormalities ◽  
Post Partum ◽  
National Average ◽  
Live Births ◽  
National Rate ◽  
Vaginal Deliveries ◽  
Inflammatory Bowel

Abstract Background This study aimed to examine the current management and outcomes in pregnancy in our cohort of inflammatory bowel disease (IBD) patients. Methods Following ethical approval patients with at least one pregnancy with known Crohn’s Disease (CD) or Ulcerative Colitis (UC) were identified. Using a self-assessment questionnaire basic demographic, clinical data and pregnancy outcomes were recorded. Results Eighty-five patients were recruited between January and October 2019; 38 CD, 26 UC and 1 Indeterminate (ID). The mean age was 28.6 years (range 14–46 years) at diagnosis. In total there were 199 pregnancies: 168 live births, 2 stillbirths (1%); lower than the national rate of 3.0 per 1000 and 29 miscarriages (14.5%) compared with national rates of 1 in 5. The majority attended routine combined GP and maternity services, only 17 (20%) attended a specific high-risk maternity clinic. Biologic usage was similar pre and during pregnancy; 16 (22%), 11 (16%) with a slight increase post pregnancy 19 (30%). Overall 26% continued to smoke and 7% drank alcohol during their pregnancy. The total of reported flares were less frequent during pregnancy 45% (n = 35) vs. pre-partum 61% (n = 47) and post-partum 79% (n = 61), p = 0.021. In all there were 138 vaginal deliveries and 32 (19%) caesarean sections (CS). CS rates did not differ by disease type, UC 9/26 & CD 26/58, p = 0.4 There were 12 (7%) preterm deliveries 3 of which had low birth weights. 2 congenital abnormalities 1 % (cleft palate and spina bifida) lower that the national rate of 2–3% of live births and 14–24% of stillbirths, were recorded. Breast feeding rates were reported at 34% (n = 28), significantly lower than the national average rate of 46.3%. 81% of patients reported having had a recent smear test and 18% reported an abnormal smear. Seventy per cent of patients who reported having an abnormal smear were on immunosuppressant therapy. Conclusion The results from our ongoing study have found less disease activity during pregnancy possibly associated with continued use of biological therapy. However, there were higher rate of flares reported post-partum possibly related loss to immune tolerance developed during pregnancy, or lifestyle and environmental factors. Despite not attending a specific IBD pregnancy service outcomes in our cohort were good with lower than National average rates of miscarriage, stillbirths and congenital abnormalities. Worryingly rates of over a quarter of patients continued to smoke during pregnancy and only a third of patients breastfed; factors which could be targets for future education. High rate of abnormal smear tests, low rate of HPV vaccination warrants further research.

scholarly journals Shared Decision Making in Pregnancy in Inflammatory Bowel Disease: Design of a Patient Orientated Decision Aid

2020 ◽  
Author(s):  
Astrid-Jane Williams ◽  
Neda Karimi ◽  
Radha Chari ◽  
Susan Connor ◽  
Mary A De Vera ◽  
...  
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Decision Aid ◽  
Post Partum ◽  
Decision Aids ◽  
Inappropriate Medication ◽  
Support Tool ◽  
Inflammatory Bowel ◽  
In Pregnancy

Abstract Objective: Research has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. Development and feasibility testing of a decision aid encompassing reproductive decisions in the setting of IBDMethods:The International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed and tested for feasibility.Results:Issues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received. Conclusions:The novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.

scholarly journals Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Astrid-Jane Williams ◽  
Neda Karimi ◽  
Radha Chari ◽  
Susan Connor ◽  
Mary A. De Vera ◽  
...  
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Decision Aid ◽  
Post Partum ◽  
Decision Aids ◽  
Inappropriate Medication ◽  
Support Tool ◽  
Inflammatory Bowel ◽  
In Pregnancy

Abstract Background Research has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD. Methods The International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility. Results Issues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received. Conclusions The novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.

scholarly journals A176 THE IMPACT OF COVID-19 ON ANXIETY, DEPRESSION, AND STRESS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A CROSS-SECTIONAL SURVEY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 188-189
Author(s):  
P Tandon ◽  
K O’Connor ◽  
C Maxwell ◽  
G C Nguyen ◽  
V W Huang
Keyword(s):  
Mental Health ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Health Care Professionals ◽  
Post Partum ◽  
Stress Symptoms ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Anxiety Depression ◽  
The Impact

Abstract Background Women with inflammatory bowel disease (IBD) are at an increased risk of mental-health illness and reduced fertility. Aims To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental-health and pregnancy plans of women with IBD. Methods Women with IBD (age 18–45) were asked to anonymously complete surveys on baseline demographics, IBD characteristics, and mental health comorbidities. They were also asked to comment on prior symptoms consistent with COVID-19 and whether they were tested for the virus. Finally, patients were asked to complete three mental health surveys to reflect on anxiety (Generalized Anxiety Disorder-7 (GAD7)), depression (Patient Health Questionnaire-9 (PHQ9)), and stress (Perceived Stress Scale (PSS)) symptoms prior to and during the pandemic. Total scores were reported as continuous variables and means with standard deviations (SD) were compared using paired T-tests. Results Twenty-nine patients (12 UC, 17 CD) were included. 14 patients were preconception, 12 were pregnant, and 3 were post-partum. The mean age was 31.4 (SD 3.7). Fifteen of 29 (51.7%) of patients were on anti-tumor necrosis factor therapy. Twelve (41.4%) and 6 (20.7%) patients had pre-morbid anxiety and depression prior to the pandemic. COVID-19 symptoms were reported in 8 patients (27.5%). Six patients had undergone COVID-19 testing, all of whom had a negative test. Four patients indicated that COVID-19 had negatively affected their plans for pregnancy, with reasons reported including fear of the hospital (n=1), fear of COVID-19 impact on the fetus (n=2), and uncertainty on the duration of COVID-19 (n=1). During the pandemic, fourteen of 28 (50%) patients experienced symptoms of anxiety (GAD score > 5), with a majority (70%) experiencing mild symptoms (score 5–9). During the pandemic, 60.7% (17/28) and 71.4% (20/28) reported symptoms of depression (PHQ9 > 4) and at least moderate stress (PSS > 14) respectively. Furthermore, compared to pre-pandemic, 57.1% (16/28) and 67.9% (19/28) had an increase in depression and stress symptoms during the pandemic respectively. This appeared to only apply to those with CD, but not UC (Table 1). Compared to pre-pandemic, those with stricturing CD appeared to have higher stress scores whereas those with fistulizing and perianal disease appeared to have higher depression scores during the COVID-19 pandemic (Table 1). A lower house-hold income and a reduction in exercise during the COVID-19 pandemic appeared to increase the risk of stress, depression, and anxiety symptoms. Conclusions Over half of women with IBD indicate worsening of anxiety, depression, and stress symptoms during the COVID-19 pandemic. It remains critical that health-care professionals address these mental health concerns during these otherwise difficult times. Funding Agencies None

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