P542 Care of women with gastrointestinal conditions during family planning and pregnancy
M. Clowse*1, M. Druzin2, M. Khamashta3, D. Pushparajah4, S. Horst5
1Duke University Medical Center, Duke University, Durham, United States, 2School of Medicine, Stanford University, Stanford, California, United States, 3Lupus Research Unit, The Rayne Institute, St Thomas Hospital, London, United Kingdom, 4UCB Pharma, Patient Affairs, Brussels, Belgium, 5Vanderbilt University, Medical Center, Nashville, United States
Gastrointestinal (GI) diseases affect women of reproductive age and can impact pregnancy outcomes. There is a need to understand how patients (pts) are managed by their physicians. We investigated the treatment pathway and care of women with GI conditions who become pregnant.
Two online surveys were conducted - one in gastroenterologists (Gastros) and one in pts - in the US, UK, Germany and Mexico. Gastros were questioned on the last 3 pts with Crohn's Disease (CD) or Ulcerative Colitis (UC) who they have consulted whilst being pregnant or considering becoming pregnant. Pt survey included women with Inflammatory Bowel Disease (IBD) who had been pregnant in the past 2 years. Pts were questioned on their interactions with Gastros and obstetrics/gynaecology physicians (OBGYN).
20 Gastros and 56 IBD pts completed the physician and pt surveys respectively. Gastros were aware of the pt's intention to become pregnant in 55% of pts. When planning their pregnancy, 41% of pts consulted with their Gastros and 50% with their OBGYN. On learning they were pregnant, 36% of pts consulted with their Gastros and 71% with their OBGYN. For Gastros, the majority of initial visits occurred prior to pregnancy (65%). During pregnancy Gastros saw 28% of pts once a month or more, 58% every trimester and 13% only once during pregnancy. 83% of pts reported that Gastros were very influential on how they managed their pregnancy. For OBGYN, this figure was 88%. The majority of pts rated the reliability of information on managing disease from both Gastros and OBGYN as very reliable. Gastros initiated a treatment plan related to management of CD/UC and pregnancy for 57% of pts. 27% of Gastros made treatment changes in anticipation of or during pregnancy. 68% of pts reported they had a treatment plan in place prior to pregnancy. When considering changes in treatment during pregnancy, Gastros decreased steroid, DMARD and NSAID use but increased use of biologics (Table).
Table: Changes in treatment for women with CD or UC who were pregnant or considering becoming pregnant
Gastros are highly involved in the treatment of pts who become pregnant or who plan to do so, and have considerable influence over the management of their condition. However, only half put a treatment plan in place related to management of CD/UC or pregnancy. Pts reported that they had a high level of interaction with both Gastros and OBGYN before and during pregnancy. This highlights the need to ensure that engagement between physicians and pts remains high and that pt concerns are alleviated throughout their pregnancy.