Does the Level of Reproductive Knowledge Specific to Inflammatory Bowel Disease Predict Childlessness among Women with Inflammatory Bowel Disease?

Abstract

I nflammatory bowel disease (IBD) affects patients in their reproductive adult years. Management of IBD can, therefore, be challenging when integrating the effects of IBD and its treatment on fertility, pregnancy, breastfeeding, and maternal and neonatal outcomes. Women with IBD have been reported to have fewer children, with reported ranges of 14% to 36% of women with IBD choosing not to have children, a decision termed 'voluntary childlessness' (1-4), compared with reported ranges of 2.5% to 28% in the general population (3). Previous reports have documented that the reasons women with IBD choose voluntary childlessness include concerns related to medicationassociated teratogenicity (2,3), the impact of pregnancy on their IBD (1), the risk of passing IBD to their child (1,2) and not being able to care for their child (1). However, many of these concerns are unsubstantiated because women with IBD, in general, have similar fertility to the general population, and are able to carry successful pregnancies and care for their infants, especially if their IBD is in remission (5-11).Several studies have reported deficits in IBD-specific reproductive knowledge among women with IBD and investigators have postulated that voluntary childlessness is due to lack of knowledge (2,4,12,13). However, the association between IBD-specific reproductive knowledge and childlessness among women with IBD is not well characterized. Current age and marital status may influence a woman's decision regarding having children; these variables have not been studied previously with respect to IBD-specific reproductive knowledge and BACKGROUND: Women with inflammatory bowel disease (IBD) may choose to remain childless due to a lack of IBD-specific reproductive knowledge. OBJECTIVES: To examine the effects of IBD-specific reproductive knowledge and discussion of family planning with a physician on childlessness among women with IBD. METHODS: Female IBD patients 18 to 45 years of age completed the Crohn's and Colitis Pregnancy Knowledge questionnaire (CCPKnow), and answered questions regarding reproductive history, plans to have children and discussion of family planning with a physician. CCPKnow scores were grouped according to poor (0 to 7), adequate (8 to 10), good (11 to 13) and very good (14 to 17). RESULTS: Of 434 eligible women, 248 (57.1%) completed the questionnaires. Of these 248 women, 51.6% were childless and, among these, 12.9% were voluntarily childless and 12.1% were trying to become pregnant. Childless women had a lower median CCPKnow score than women with children (6.0 versus 8.0; P=0.001). After adjusting for current age and marital status, each one point increase in the CCPKnow score corresponded to 8% lower odds of childlessness (OR 0.92 [95% CI 0.86 CONCLUSION:In the present study, higher IBD-specific reproductive knowledge lowered the odds of childlessness among women with IBD. Discussion of family planning with a physician was associated with higher CCPKnow scores and lower odds of voluntary childlessness.

Systematic review: the consequences of psychosocial effects of inflammatory bowel disease on patients′ reproductive health

“…Moreover, female patients with poor CCPKnow scores more likely to be voluntarily childless than women with adequate or higher CCPKnow scores (59.5% vs 42.7%, P = 0.008). Every point increase in CCPKnow score corresponded to 8% lower odds ratio of childlessness . Other factors associated with childlessness included older age (35 years vs 28 years; P < 0.001), being single (34.5% vs 9.3% with children; P < 0.001), older age at diagnosis (25.6 years vs 21.9 years; P < 0.001) and longer disease duration (13 years vs 8 years; P < 0.032), however poor pregnancy‐related knowledge was the strongest predictor of childlessness …”

“…Patients who received pre‐conception counselling from healthcare professionals were less likely to be voluntarily childless . Multivariate logistic regression analysis estimated that discussing family planning with a physician corresponded to 56% lower odds of having a poor CCPKnow score and 72% lower odds of voluntary childlessness . Specifically, the adjusted OR (for current age and marital status) is 0.28 (95% CI 0.057‐1.3) for the effect of having discussed family planning with a healthcare professionals on voluntary childlessness among childless women …”

“…Some 40%‐68% of patients do not discuss family planning with their healthcare professionals . Patients who received pre‐conception counselling from healthcare professionals were less likely to be voluntarily childless .…”

“…Higher levels of pregnancy and fertility knowledge are associated with parenthood and lower levels of pregnancy and fertility knowledge are associated with voluntary childlessness. Several observational studies have found preconception counselling is associated with patients choosing parenthood however only a single observational study illustrated a predictive association between preconception counselling and reduced odds of voluntary childlessness . Pregnancy‐related fears and concerns are multifaceted and often stem from lack of knowledge and, higher levels of pregnancy‐related fears are associated with voluntary childlessness.…”

Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening (Preprint)

“…A growing body of literature now suggests that the majority of IBD medications are low risk for use during pregnancy and even lactation [6]. Despite this, observational studies note that women -particularly those with CD -have higher rates of voluntary childlessness due to concerns surrounding medication side effects, passing the disease to their offspring, fear of infertility and advice given by treating physicians [7,8]. Moreover, many women perceive medications to be unsafe during pregnancy [9][10][11].…”