P678 Factors associated with voluntary childlessness in women with inflammatory bowel disease
C. Selinger*1, J. Ghorayeb2, A. Madill2
1St James University Hospital, Gastroenterology, Leeds, United Kingdom, 2University of Leeds, School of Psychology, Leeds, United Kingdom
Inflammatory bowel disease (IBD) affects many women of child bearing age, but it requires complex decision making around pregnancy. Although infertility is only slightly increased, many women decide against having children. Voluntary childlessness (VC) rates exceed those of the general population by far. The reasons for VC remain incompletely understood.
Approximately 4 300 female members of the patient organisation Crohn’s and Colitis UK aged 18–45 years were asked by e-mail to complete an online questionnaire. Data collection included patient demographics, education, employment, marital status, and disease characteristics. Childlessness status and patient views were assessed as in the previous study by Marri (2007). Disease-related pregnancy knowledge was recorded with the validated CCPKnow score.
In total, 1 324 women with mean age of 33 years completed the survey (response rate 31%). Of these 76% were in a long-term relationship, and 87% were in employment or education. Further, 776 (59%) suffered from Crohn’s disease (CD); 496 (38%) from ulcerative colitis (UC); and 4% from IBD-U. In addition, 40% had children (14% pre-diagnosis [I]; 26% post diagnosis [II]); 36% planned to have children at some stage (III); 7% reported fertility problems (IV); and 17% were classified as voluntarily childless (VC). Further, 673 patients had sought medical advice about pregnancy and IBD. VC was associated with poorer disease-related knowledge (CCPKnow 5.98 vs 7.47 in [II]; p < 0.001), older age (35y vs 28y in [II]; p < 0.001), unemployment (9.7% VC; p < 0.001), being single (34.5% VC; p < 0.001), not seeking medical advice (p < 0.001), and diagnosis of CD (19.3% vs 13.9% UC; p = 0.015). Women with VC had more hospital admissions (mean 2.85 vs 2.17 [III]; p = 0.03) and surgical interventions (mean 1.27 vs 0.65 [III]; p < 0.001). Exposure with different types of IBD medication was not associated with VC. The main patient concerns were around inheritance (20.6%), inability to cope with a child (20.6%), and the influence of pregnancy on IBD (18%).
VC occurs frequently in women with IBD, and it appears to be multifactorial. Disease type and severity influence VC. Differences in disease burden could explain why VC is more common in CD than in UC patients. Patients are mostly concerned regarding inheritability, disease course, and the ability to cope with the added stress of being a mother. VC is associated with poor pregnancy-specific knowledge, and many women may stay childless unnecessarily. Patient education programmes may help to reduce the rate of VC by correcting misconceptions and alleviating patient concerns.