P409. Physician knowledge of reproductive issues in inflammatory bowel disease is highly variable
V. Huang1, K. Kroeker2, K. Goodman2, L. Dieleman2, R. Fedorak2, 1University of Alberta, Edmonton, Canada, 2University of Alberta, Canada
Reproductive care during inflammatory bowel disease (IBD) can be challenging in its multifactorial nature. Physicians must consider the impact of IBD and its treatment on fertility, pregnancy, and neonatal outcome. While women with inactive IBD have outcomes similar to the general population, patients with active IBD are faced with decreased fertility and varied fetal outcomes. There is a higher rate of voluntary childlessness in women with IBD compared to the general population, with this decision often being made because of the IBD diagnosis. Our previous study assessing patient knowledge of reproductive issues in IBD demonstrated that patient knowledge regarding reproductive issues in IBD was poor, despite 50% reported discussing these issues with their physicians. The aim of this study was to assess, in physicians treating women with IBD, their IBD-related reproductive knowledge and their practice in discussing this knowledge with IBD patients.
Physicians attending a national IBD conference, and a provincial gastroenterology for general practitioners conference both in 2012, were invited to complete a survey package consisting of: 1) Crohn's and Colitis Pregnancy Knowledge (CCPKnow) score and 2) questionnaire regarding individual practice patterns. The validated CCPKnow score differentiates between poor (0–7), adequate (8–10), good (11–13) and very good (14–18) reproductive knowledge.
The response rate was 53% (85/160). Gastroenterology trainees, general internists and gastroenterologists scored, 15.8+2.2, 17.0+1.4, and 16.9+1.7, and had higher CCPKnow scores than general practitioners (9.8+3.7) (p < 0.001). Characteristics that significantly influenced CCPKnow included years in practice, type of practice, total number of IBD patients and pregnant IBD patients seen per year. There were significant deficits in physician knowledge and use of medications in the reproductive period, some of which could be harmful to the pregnancy. Gastroenterologists (87%) and general internists (100%) were more likely to discuss family planning. Physicians with very good CCPKnow (84%) were more likely to discuss family planning and address medication issues appropriately.
This is the first study to demonstrate that general practitioners have limited knowledge regarding reproductive issues in IBD compared to specialists. Furthermore, despite good knowledge, gastroenterologists and general internists have widely varied practices regarding the management of pregnant IBD patients.