Family planning with inflammatory bowel disease: the challenge of childlessness and parent concerns

Abstract

Background In patients with inflammatory bowel disease (IBD), diagnosis is often established at the beginning of childbearing age. Accordingly, concerns about family planning and pregnancy (FPP) are common. Poor knowledge regarding FPP might contribute to increased childlessness in patients with IBD. Methods The Crohn’s and Colitis Pregnancy Knowledge Score (CCPKnow, 17 multiple-choice questions) was translated into German and then used for a web-based survey. Childlessness was analyzed with respect to socio-demographic and disease-related information, and the knowledge (CCPKnow) and concerns of IBD patients with children were compared to those of voluntarily childless (VC) and non-voluntarily childless (NVC) IBD patients. Results Childlessness was observed in 57.4 % of the 533 participants (90.6 % women, 63.0 % Crohn’s disease, 31.5 % ulcerative colitis, mean age 33.2 ± 8.6 years), voluntary childlessness in 9 %. The mean overall CCPKnow was adequate (9.38 ± 3.96). Poor knowledge was not associated with increased childlessness (CCPKnow of < 8 was found in 29.8 % of patients with children and 28.9 % of childless patients, p > 0.5). Instead, the patients’ education, medical advice, FPP-related concerns, impaired body image, and sexual dysfunction had a significant impact on childlessness. Frequent concerns included adverse effects of the patient’s medication on their child (36 % of the respondents), malformation (33 %), miscarriage (34.5 %), and the inheritability of IBD (57 %). Conclusions Factual knowledge does not reduce disease-related concerns or childlessness. Correct but possibly bothersome information on FPP might contribute to childlessness in patients with IBD. Our findings underline the need for qualified counseling of IBD patients regarding FPP by an experienced IBD physician.

Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data

“… 32 Evidence on the association between parity and chronic conditions is limited, but it does suggest that the prevalence of having children is up to 22% lower in affected women. 33 – 36 Thus, omitting parity from the analysis may result in confounding of the OR between chronic conditions and urinary incontinence. Previous work has shown that the size of this confounding bias, termed the relative risk due to confounding (RR C ), can be estimated using 3 values: the prevalence of the confounder in both the exposed and unexposed, and the association between the confounder and the outcome.…”

Review of pregnancy in Crohn’s disease and ulcerative colitis

“…In addition to providing standard antenatal education, counseling should address patient misconceptions about infertility, medication safety, maternofetal complications, and IBD heritability, which are common concerns in IBD patients and contribute toward VC. [96][97][98][99] This is associated with improved medication adherence, folic acid supplementation, smoking cessation, reduced disease flares during pregnancy, and improved neonatal outcomes. [100][101][102] In women actively contemplating pregnancy, medication review for risk of teratogenicity and objective assessment of disease activity should be performed prior to conception, aiming to confirm disease remission to optimize pregnancy outcomes.…”

Inflammatory bowel disease negatively impacts household and family life

“…Feeling unable to cope with the added responsibility of looking after a child or concerns about pregnancy, such as the risks of medication with respect to pregnancy or potential heredity of IBD, are frequently reported. [12][13][14] These facets impose a significant extra burden on patients, while remaining challenging to quantify.…”