Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society

Abstract

BackgroundPregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD.AimTo develop a position statement on service set-up and minimum standards of care in the UK.MethodsA working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters’ feedback after each round. Statements with ≥80% agreement were accepted.ResultsAll 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended.ConclusionPosition statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.

Inflammatory bowel disease in pregnancy: Developing a multidisciplinary care pathway in East London

“…Firstly, optimal care for women with IBD in pregnancy ought to start pre-conceptually. 12,13 This is important for several reasons, not least to educate women about their condition, family planning (including contraception), effect of IBD on the pregnancy and the effect of pregnancy on IBD, safety of medications in pregnancy and breastfeeding.…”

“…A recent position statement has been released from the British Society of Gastroenterology and British Maternal and Fetal Medicine Society to help units organise specific services and advise minimum standards of care for pregnant women with IBD. 12 In addition, the American Gastroenterological Association have also developed a clinical care pathway for pregnancy and IBD. 13 Our aim was to evaluate the experience of caring for this patient group in our East London maternity unit over the course of one year, with the overriding aim to identify any aspects of care that could be improved in order to achieve positive pregnancy and neonatal outcomes.…”

“…A recent position statement has been released from the British Society of Gastroenterology and British Maternal and Fetal Medicine Society to help units organise specific services and advise minimum standards of care for pregnant women with IBD. 12 In addition, the American Gastroenterological Association have also developed a clinical care pathway for pregnancy and IBD. 13…”

Impact of the coronavirus infectious disease (COVID-19) pandemic on the provision of inflammatory bowel disease (IBD) antenatal care and outcomes of pregnancies in women with IBD

“…11 Women of childbearing age with coexisting IBD should be counselled on fertility, efficacy of contraceptives, medications used to control IBD, teratogenicity and delivery methods. 12 Approximately, a third of patients in remission will relapse, 13 with almost two-thirds with active disease at conception having further flare ups during pregnancy. 14 15 This is especially important as active IBD is considered an independent risk factor for poorer outcomes from COVID-19 in general and hence optimal disease control during pregnancy is vital for both the pregnant woman and the foetus.…”

Highlights from this issue

“…The British Society of Gastroenterology and British Maternal and Foetal Medicine Society have recently published guidance on service setup and minimum standards for care for pregnant women with Inflammatory Bowel Disease (IBD). 1 In this issue Wollof et al survey the current landscape. In summary the findings suggest that in many units there is a lack of robust systems to manage IBD during pregnancy and that input and communication with obstetric services is adhoc and not regular.…”