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P633. Decision-making, counselling and course of pregnancy in female inflammatory bowel disease patients

Background

Inflammatory bowel disease (IBD) often affects women in their reproductive years. The influence of their disease on pregnancy is of great concern to IBD patients. This study aimed to assess decision-making, counselling and outcome of pregnancy in women with IBD treated in a general hospital.

Methods

All female IBD patients under regular control in two general hospitals were asked to complete a survey regarding decision-making, counselling, pregnancy outcome and disease activity. For all patients included in the study clinical records were also reviewed.

Results

From a total of 760 women with IBD, 385 (51%) completed the survey: 185 (48%) had Crohn's disease, 197 (51%) had ulcerative colitis and 3 (1%) had indeterminate colitis. Median age of respondents was 44 years (IQR 33–56). Median age at diagnosis of IBD was 30 years (IQR 21–40). In total, 115 patients (30%) had received counselling on pregnancy of whom 5 (4%) thought the quality was poor. Of women who were not counselled, 15 (6%) were dissatisfied about this. In total, 113 (29%) women had never been pregnant, for most (n = 78, 69%) this was a conscious decision, unrelated to the presence of IBD. Having IBD was partly related to not becoming pregnant in 20 women (18%), of whom 9 (8%) consciously refrained from pregnancy due to their disease. Of 275 women that had been pregnant, 99 women had a total of 156 pregnancies after IBD diagnosis. Median time between diagnosis and subsequent pregnancy was 5 years (IQR 3–8). Having IBD had no influence on the wish to become pregnant after diagnosis in 113 of 156 pregnancies (72%). Immunosuppressive drugs were used before pregnancy in 36 cases (23%), of which anti-TNF agents were used in 7 (5%). In 9 cases (6%), immunosuppression was stopped before pregnancy. Disease activity increased during pregnancy in 30 cases (19%), requiring immunosuppressive drugs in 9 cases. Pregnancy-related complications such as preeclampsia occurred in 18 cases (12%). The frequency of pregnancy-related complications did not differ significantly between women with or without immunosuppressive medication (17% vs 10%, respectively, p = 0.249). The number of preterm births was higher (24% vs 11%, p = 0.090) and mean birth weight was lower (3047 vs, 3310 grams, p = 0.034) in patients on immunosuppressive drugs.

Conclusion

In female IBD patients from a general hospital, counselling on pregnancy appears satisfactory. The presence of IBD seems to impact women's decision-making regarding pregnancy in only a minority of cases. The outcome of pregnancies after IBD diagnosis is generally good. However, preterm birth and lower birth weight are more frequent in women using immunosuppressive drugs. Especially these latter patients require active monitoring during pregnancy.

  • Written by:

    J. Hoekstra1, J. Baars1, A. van Roon1, M. Kimmel1, M. Zwijnenburg2, F. Bekkering2, A. van Tilburg1, R. West1, 1Sint Franciscus Gasthuis, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2IJsselland Hospital, Gastroenterology and Hepatology, Capelle aan den IJssel, Netherlands