Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

Bae

et al. 2020

Aliment Pharmacol Ther

Background: Data relating to the association between inflammatory bowel disease (IBD) and pregnancy outcomes are lacking in Korea. Aims:To determine the incidence rates of pregnancy outcomes in women with IBD.Methods: A nationwide population study was performed using the Korean National Health Insurance claims database. A total of 2058 women with IBD consisting of ulcerative colitis (UC, n = 1469) and Crohn's disease (CD, n = 589) were pregnant between 2007 and 2016. We compared their incidence of pregnancy outcomes with 20 580 age-matched controls without IBD. We also stratified the patients into those with quiescent to mild and moderate to severe IBD and compared the outcomes between them. Results:The pregnancy rate of women with IBD was lower than that of women without (25.7% vs 32.3%, P < 0.001). Caesarean section (46.5% vs 38.8%, odds ratio [OR]1.43, 95% confidence interval [CI]: 1.17-1.75), and intrauterine growth retardation (IUGR) (3.0% vs 1.0%, OR 2.89, 95% CI: 1.59-5.26) were increased in CD patients than the controls. In regards to disease severity, there were no significant differences in pregnancy outcomes between patients with quiescent to mild IBD and the controls. However, the live birth rate of patients with moderate to severe IBD was lower than that of the controls (65.0% vs 69.9%, OR 0.79, 95%CI: 0.66-0.94). In addition, moderate to severe IBD was significantly associated with spontaneous abortion (14.9% vs 11.9%, OR 1.33, 95% CI: 1.04-1.68), caesarean section (46.4% vs 38.8%, OR 1.41, 95% CI: 1.14-1.74) and IUGR (3.4% vs 1.0%, OR 3.20, 95% CI: 1.75-5.84). Conclusions:With the exception of moderate to severe disease, the incidences of adverse pregnancy outcomes in women with IBD are similar to that of the general population.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in women with inflammatory bowel disease: a 10‐year nationwide population‐based cohort study

Bae

et al. 2020

Aliment Pharmacol Ther

“…Other IBD treatments can be continued in the postpartum period. MTX can be restarted postpartum if the mother is not lactating [114].…”

Section: Postpartummentioning

confidence: 99%

“…Patients with an ostomy are more at risk of stoma complications during pregnancy and after delivery. It is recommended to avoid excessive weight gain during pregnancy and seek for advice to colorectal surgeon and a specialist nurse [114]. In case of cesarean section, simply covering the ostomy with gauze is sufficient to protect the operative field [116].…”

Section: Postpartummentioning

confidence: 99%

Update on the Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding

et al. 2020

Inflammatory bowel disease (IBD) affects patients during their peak reproductive years. This raises important questions, in both patients and healthcare providers, regarding conception, pregnancy, and breastfeeding. Lack of information and insufficient communication among healthcare providers can leave patients with limited information and even contradictory advice. Given the fact that pregnant and/or breastfeeding IBD patients are excluded from clinical studies the evidence on many questions related to pregnancy and postpartum period is limited. However, there exists increasing data from case series and cohort studies that allows to provide clinical guidance. The overarching concept is that optimizing the mother's health is critical for optimizing the health of the unborn child and benefit of continuing medical therapy in IBD during pregnancy outweighs possible risks in most instances. This paper provides an up-to-date systematic review of the literature on IBD in pregnancy and proposes guidance to questions frequently encountered by healthcare professionals.

“…I was proud to be part of the Parenthood Project, a national committee that developed guidelines for caring for pregnant patients with IBD [7].…”

Section: Women's Healthmentioning

confidence: 99%

DDS Perspective: Reflections of a Woman in Gastroenterology

Friedman

2019

Dig Dis Sci

Self Cite

When I finished my gastroenterology fellowship in 1999, only about 10% of the gastroenterologic (GI) attending physicians were women [1]. I always considered that an advantage, not an obstacle. At least 50% of GI patients are women, and women prefer female endoscopists [2-6]. I quickly realized that as a recent female GI graduate, I might have better career opportunities than my male colleagues. In 1999, multiple GI practices were recruiting women because that is what their patients demanded [2-4]. While there were long waiting lists to see the sole female endoscopist in a given practice, many male endoscopists were searching for patients. In general, women feel more comfortable talking about gas, bloating, diarrhea, pelvic pain, and menstrual symptoms with other women. I have heard male senior gastroenterologists say that only female gastroenterologists should care for female patients. Yet by relegating "women's GI issues" to women physicians, the medical establishment diminishes not only female patients and their problems, but also the science behind the practice of medicine. A scientific approach to illness accounts for differences among all people and respects all patients regardless of gender. Women gastroenterologists should have been equally compensated, but that was far from the case in 1999 and the early 2000s. Like the US women's soccer team members who are widely popular and have gained world recognition with multiple stunning victories but are paid a pittance compared with the US men's soccer team, women gastroenterologists have been consistently undervalued and undercompensated. Although I was specifically recruited as an inflammatory bowel disease (IBD) expert and not a specialist in women's health (which was not thought to be a legitimate field at the time), my starting salary was significantly less