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Self-reported adherence to medical treatment prior to and during pregnancy among women with ulcerative colitis

Julsgaard, Mette MD1*; Nørgaard, Mette MD, PhD2; Hvas, Christian Lodberg MD, PhD1; Buck, Daniel BScEE2; Christensen, Lisbet Ambrosius MD, DMSc1

doi: 10.1002/ibd.21522
Original Clinical Articles

Background: Adherence to medical treatment among women with ulcerative colitis (UC) prior to and during pregnancy has never been investigated. The aim was to examine predictors for and prevalence rates of nonadherence to maintenance treatment among women with UC prior to and during pregnancy.

Methods: We identified 115 women with UC having given birth during 2000-2005 within a population of 1.6 million. They received a questionnaire about predictors and adherence and relapses were registered. We retrieved information on medical treatment from prescription databases and used logistic regression to estimate prevalence odds ratios (POR) for nonadherence by different predictors.

Results: Among 93 (81%) respondents, 63 (68%) reported taking medication, 53 of whom had filled prescriptions for relevant medication, yielding a positive predictive value of self-reported use of medical treatment of 84.1% (95% confidence interval [CI] 72.7-92.1). Approximately 60% reported adhering to medical treatment. Those who received counseling regarding medical treatment were less likely to be nonadherent compared with no counseling, especially during pregnancy (POR 0.2, 95% CI 0.04-0.94). Of those who were nonadherent, fear of a negative effect on fertility/fetus was stated as the reason by 23% prior to and by 50% during pregnancy. Notably, 40.3% reported an episode of relapse during the pregnancy period, compared with 13.6% in the period 6 months prior to pregnancy.

Conclusions: Adherence was high despite fear of a negative effect on fertility or the fetus. Counseling predicted higher adherence. This may be important because our study suggests an increase in UC activity during pregnancy. (Inflamm Bowel Dis 2010)

1 From the Department of Medicine V, Aarhus University Hospital, Aarhus C, Denmark

2 Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark

* Department of Medicine V (Gastroenterology and Hepatology), Aarhus University Hospital, Noerrebrogade 44, building 1C, 1st floor, DK-8000 Aarhus C, Denmark


Received 19 August 2010; Accepted 13 September 2010

Published online 9 December 2010 in Wiley Online Library (

Grant sponsor: Danish Colitis-Crohn association; Grant Number: 8889; Grant sponsor: A.P. Moeller Foundation of the Advancement of Medical Science; Grant sponsor: Danish Ministry of Health; Grant Number: 271-05-0775\.

Funded in part by the Danish Colitis-Crohn association (grant number 8889) and the A.P. Moeller Foundation of the Advancement of Medical Science. The Danish Ministry of Health has financially supported Dr. Mette Julsgaard (identification number 271-05-0775). The funding in no way affected the study design, collection, analysis, interpretation of the data or the writing of the report.

© Crohn's & Colitis Foundation of America, Inc.
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