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Decision making and outcome of pregnancies in female patients with inflammatory bowel disease: findings from a community-based practice

Hoekstra, Jildoua,b; van Roon, Aafke, H.C.a,b; Bekkering, Frank, C.c; van Tilburg, Antonie, J.P.a; West, Rachel, L.a

European Journal of Gastroenterology & Hepatology: July 2018 - Volume 30 - Issue 7 - p 704–708
doi: 10.1097/MEG.0000000000001117
Original Articles: Gastroenterology

Introduction The aim of this study was to evaluate information provided on pregnancy, personal decision making, disease course, and outcome of pregnancy from a patient’s perspective in a population of patients with inflammatory bowel disease (IBD) attending two general hospitals.

Patients and methods A questionnaire was sent to all female patients with IBD in two general hospitals in the Netherlands. The questionnaire comprised four sections: (i) demographic data and medication use (ii) details on previous pregnancies and reasons for not becoming pregnant, (iii) outcome of pregnancies before IBD diagnosis, and (iv) outcome of pregnancies after IBD diagnosis. If necessary, medical records were reviewed to verify responses or for further medical details.

Results In total, 385 women returned the questionnaire, 501 completed pregnancies were reported, and 113 women had never been pregnant. In 272 women with at least one pregnancy, 334 pregnancies occurred before IBD diagnosis, 157 after IBD diagnosis, and in 10 cases, IBD was diagnosed during pregnancy. Medication for IBD was used in 67% of pregnancies after IBD diagnosis, mainly 5-ASA preparations (54%). Women with ulcerative colitis experienced more IBD-related complaints during pregnancy compared with women with Crohn’s disease (25 vs. 14%, P=0.016). Additional medication (n=21) or surgery (n=2) for IBD during pregnancy was indicated in 14% of cases. Most women reported an uneventful pregnancy course (79%). Preterm birth occurred in 13% of pregnancies.

Conclusion Pregnancy in women with IBD seen in a general hospital can be managed with a good outcome. Step-up therapy is needed in a minority of cases, and severe complications are rare.

aDepartment of Gastroenterology, Franciscus Gasthuis and Vlietland

bDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam

cDepartment of Gastroenterology, IJsselland Hospital, Capelle a/d IJssel, The Netherlands

Correspondence to Rachel L. West, MD, PhD, Department of Gastroenterology, Franciscus Gasthuis and Vlietland, Postbus 10900, 3004 BA Rotterdam, The Netherlands Tel: +31 10 461 6161; e-mail: r.west@franciscus.nl

Received January 16, 2018

Accepted February 21, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.