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Establishment of the first inflammatory bowel disease in pregnancy multidisciplinary service in New South Wales
Journal of Gastroenterology and Hepatology ; 37(Supplement 1):163, 2022.
Article in English | EMBASE | ID: covidwho-2088258
ABSTRACT
Background and

Aim:

Inflammatory bowel disease (IBD) commonly affects men and women during their reproductive years. Misconceptions surrounding the impact of IBD and associated therapies on the peripartum period contributes to increased rates of voluntary childlessness. Navigating IBD and obstetric-related decisions during pregnancy can be challenging. We established a monthly multidisciplinary clinic comprising a gastroenterologist, IBD nurse, and obstetric fellow, in addition to dietetic and psychological referral pathways, to optimize care for women with IBD in the peripartum period.We aim to describe the patient cohort and associated pregnancy-related outcomes. Method(s) Between January 2021 and May 2022, 43 women were referred to the multidisciplinary pregnancy in IBD clinic for the indications of preconception counseling or IBD care during pregnancy and postpartum. The consultations were conducted face-to-face or via telehealth due to the impact of the COVID-19 pandemic. Nutritional and psychological screening occurred before clinic review, while intestinal ultrasound (IUS) was done as needed;however, the latter was limited due to COVID-19-related clinical restrictions. A review of prospectively collected patient records, including the use of Crohn's Colitis Care (CCCare), was performed to obtain demographic data, medical and surgical history, and obstetric outcomes. Patients referred for preconception counseling were prospectively assessed using the decisional conflict scale (DCS) and Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow). Result(s) Of the 43 women (mean age, 30.9 years) who received care in our clinic, 14 were at preconception stage, and 29 were pregnant. Twenty-one patients had a diagnosis of ulcerative colitis, 19 had Crohn's disease, and one had IBD-unclassified. Two additional patients with pregnancy-onset IBD did not yet have a confirmed diagnosis, as their endoscopic assessment was deferred until after delivery. The mean DCS score for women referred for preconception counseling was 39.1 (>37.5 being associated with decision delay and difficulty with implementation). The median CCPKnow score at baseline was 7/18 (range, 3-11), suggesting poor IBD and pregnancy-related knowledge. The median score improved to 9/18 (range, 4-11) at 1 month follow-up and to 11/18 (range, 4-13) at 3 months. Nineteen patients (44.2%) were prescribed 5-aminosalicylates alone, eight (18.6%) thiopurines, and 21 (48.8%) biologic therapy (antitumor necrosis factor agents, 12;ustekinumab, 6;vedolizumab, 3). Eleven of 29 patients (37.9%) had active disease at conception, as assessed through symptomatic, biochemical, and radiological assessment. Two patients (4.7%) were prescribed oral budesonide during pregnancy. Five of 29 patients (17.2%) were assessed using IUS, while none required endoscopic assessment during pregnancy. Fifteen of 29 patients (51.7%) have given birth to date, with 12 (80%) having an uncomplicated vaginal delivery and three (20%) having a caesarean section, temporally compared with a caesarean section rate of 32.5% in the general South West Sydney Local Health district population. None were indicated for known perianal Crohn's disease. There have been no cases of preterm birth or pregnancy. The mean birth weight was 3.53 kg (range, 2.67-4.29). Two of 15 women (13.3%) experienced a postpartum flare. Nine of 15 women (60%) breastfed, while three (20%) formula-fed, and the remaining three (20%) mixed-fed their infants. Conclusion(s) Establishment of a multidisciplinary clinic has enabled provision of IBD care in the reproductive stage of life, with the ongoing aim to minimize the impact of voluntary childlessness through the delivery of dedicated clinic sessions for preconception counseling and the negative impact of active disease on obstetric and maternal outcomes.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Gastroenterology and Hepatology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of Gastroenterology and Hepatology Year: 2022 Document Type: Article