Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease

Abstract

Adherence to medical treatment in the postpartum period was high, and counselling seemed to increase adherence. Relapse may be explained by non-adherence or smoking while breast-feeding seemed protective.

Care of the Pregnant Patient With Inflammatory Bowel Disease

“…18 Discontinuation of medications can lead to an active disease flare, which is a greater risk to the pregnancy than any potential adverse medication effects. In general, most medications used to treat inflammatory bowel disease, with the exception of methotrexate, are considered low risk and can be continued during pregnancy and breastfeeding (Table 2).…”

“…The greatest risk of flare occurs when women discontinue medications. 18 On the other hand, medications that are contraindicated in pregnancy such as methotrexate should be discontinued at least 3 months, but preferably 6 months, before attempting conception. Effective maintenance medications should be continued.…”

Adherence and quality of care in IBD

“…This result is consistent with the findings of previous studies. [7,16,17] When stratifying for drug type, the lowest adherence rates were found for patients with inactive disease who were treated with 5-ASA or topical treatments. 5-ASA is primarily used as maintenance therapy or treatment for mild disease activity, and lower adherence rates among patients with inactive disease who received 5-ASA have been reported in earlier studies.…”

“…However, previous Danish studies of female patients with IBD from a similar cohort have found a very high concordance between selfreported medical treatment and the data from the Danish prescription database. [17,29] The study was a single centre design which could be a limitation. On the contrary, a single centre study design can ensure consistency in the data quality.…”

“…However, ad hoc questionnaires targeting the actual IBD-population could increase the willingness to respond to the questions. [17,29] We asked the patients to categorize their level of adherence (0-49%, 50-80% and 81-100% of the recommended daily dose or not applicable). We could have asked the patients to respond on a visual analogue scale from 0% to 100%, but we decided that it would be more understandable to ask the patients if they took more or less than 50% of the medication or even more than 80%.…”