Facilitators and Barriers of Preconception Care in Women With Inflammatory Bowel Disease and Rheumatic Diseases

Abstract

Background: Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). However, at present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.Methods: A survey study among women with IBD and RD, their treating physicians as well as obstetric professionals was performed. Patients, visiting the outpatient clinic of a university medical center and a secondary hospital located in the Netherlands with a wish to conceive, pregnant women or those with a recent pregnancy (<1 year ago) and involved physicians and obstetric professionals were eligible. Results: A total of 71% of the IBD patients (n=22/31) and 35% of the RD patients (n=20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. A total of 67% (n=31) of the included healthcare professionals agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n=16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n=1) and 75% (n=3) of gastroenterologists and rheumatologists, respectively. Conclusion: Facilitators and barriers have been reported both on a patient and healthcare professional level. Despite the positive attitude towards PCC on both levels, realization of PCC remains difficult. In the future, in order to facilitate optimal PCC to high risk patients as standard of care, it is necessary to remove these barriers. Trial Registration: not applicable.