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P392. Patient knowledge of reproductive issues in inflammatory bowel disease is only one of many factors that affect decisions regarding family planning

V.W. Huang, K.I. Kroeker, K.J. Goodman, K.M. Hegadoren, R.N. Fedorak, University of Alberta, Medicine, Edmonton, Canada

Background

Inflammatory bowel disease (IBD) affects patients in their reproductive years. Studies have shown that women with IBD often choose not to have children. This “voluntary childlessness” has been attributed to patient concerns regarding possible adverse effects of their IBD and its treatment on fertility, pregnancy and the newborn. We sought to understand if a lack of IBD-specific reproductive knowledge was associated with childlessness.

Methods

Female IBD patients (18–45 yrs) from the University of Alberta IBD clinic were consented to complete a survey containing questions on the following: demographics; IBD and reproductive history; family planning status; IBD-specific reproductive concerns; previous family planning discussions; Crohn's and Colitis Pregnancy Knowledge (CCPKnow) score. CCPKnow ranges from 0 to 17 indicating poor (0–7), adequate (8–10), good (11–13), very good (14+) knowledge. The median CCPKnow score between groups was compared using nonparametric tests. Multivariate logistic regression was used to determine adjusted odds ratios (aOR, 95% CI) for CCPKnow association with having children.

Results

A total of 247 out of 408 (61% response rate) women completed the survey. The average age was 31.8±7.7 yrs; 59.9% had CD; 26.9% were single; 55.1% had ever been pregnant; 48.2% had biological children. The median CCPknow score was 7.0 (0–16); childless women had lower CCPKnow than women who have children (6.0 vs. 8.0, p = 0.002). Women were more likely to have children if they had a higher CCPKnow (aOR 1.956, 1.012, 3.781) and had discussed family planning with a physician (aOR 1.142, 0.567, 2.301). Childless women had more IBD-specific reproductive concerns than women who have children (Table 1). Among childless women who were married/in a relationship, they were more likely to be “trying to become pregnant” (n = 13) if they had higher CCPKnow (aOR 6.579, 1.164, 37.178). All 13 indicated they had discussed family planning with a physician.

Table 1. Childless women have more concerns than women with children
IBD-specific reproductive concernsChildlessHave childrenp-value
N(%)N(%)
Genetically passing disease68/10763.640/10338.8<0.001
Medication related birth defects64/10759.835/10334.0<0.001
Worsening of IBD during pregnancy58/10754.239/10238.20.021
Decreased fertility54/10750.512/10311.7<0.001
IBD related fatigue51/10747.734/10233.30.035
Added stress of having a child43/10640.628/10327.20.041
Birth defects from chronic illness43/10740.217/10316.5<0.001

Conclusion

Women with IBD who are childless have less IBD-specific reproductive knowledge and more IBD-specific reproductive concerns than women with IBD who have children. Furthermore, they are less likely to discuss family planning with a physician. There is a need to improve patient IBD-specific reproductive knowledge, and physicians need to discuss family planning with their patients.