Systematic review: the consequences of psychosocial effects of inflammatory bowel disease on patients′ reproductive health

Abstract

Summary Background High levels of voluntary childlessness and pregnancy‐related fears have been reported amongst inflammatory bowel disease (IBD) patients. Aims To investigate what factors determine IBD patients’ childbearing decisions; and to examine psychosocial consequences of IBD on various aspects of patients' reproductive health. Methods Six electronic databases were searched in a pre‐specified and structured manner. Results A total of 41 articles with data on 7122 patients were included. Between one‐fifth to one‐third of IBD patients had chosen voluntary childlessness. Around 50% of all IBD patients have poor knowledge of pregnancy‐related issues in IBD. Poor knowledge of pregnancy‐related issues in IBD was associated with voluntary childlessness. Observational studies have found preconception counselling is associated with patients choosing parenthood. Pregnancy‐related fears and concerns are multifaceted, stemming partly from lack of knowledge of pregnancy‐related issues in IBD. Many female patients are considered at increased risk for pregnancy because between one‐fifth to one‐third of patients do not use contraception. Research evidence for sexual dysfunction after disease diagnosis and treatment is inconsistent. There are limited data on patients’ pregnancy, postpartum and parenting experiences. A few shortcomings of the literature are evident; sample sizes were small, participation rates were low, use of non‐validated questionnaires was common, and few studies included men and/or ethnic minority groups. The design of intervention studies is also weak. Conclusion This review recommends pre‐conception counselling for all IBD patients of childbearing age to tackle poor knowledge and allow patients to make an informed decision on their reproductive health.

Preconception Care Program for Women with Inflammatory Bowel Disease Using Intervention Mapping: A Protocol for Program Development

“…By reviewing several previous studies, we confirmed that most women of childbearing age with IBD have considerable anxiety about pregnancy due to the exacerbation of the disease during pregnancy, potential difficulties in becoming pregnant, and the possible inheritance of IBD [ 32 , 33 , 34 ]. This anxiety is related to misinformation about pregnancy, and the resultant anxiety contributes to voluntary childlessness [ 13 , 35 ].…”

“…Therefore, this study is very meaningful in that it is the first study to attempt to prepare women with IBD in Korea for pregnancy and that it presents the development of a program for behavioral change. Preconception education should be offered to women with chronic disease as soon as the disease is diagnosed to reduce any excessive anxiety about pregnancy and ensure a healthy pregnancy [ 33 ]. Any woman of childbearing age is subject to preconception education, and the content is not limited to pregnancy: it includes the overall reproductive health of women with IBD.…”

Addressing pregnancy‐related concerns in women with inflammatory bowel disease: Insights from the patient's perspective

“…Qualitative research examining the pregnancy‐related concerns and perceptions of women with IBD in the era of widespread immunomodulator and biologic medication use does not exist 11 . Therefore, we performed a qualitative study to explore the current impact of IBD on reproductive planning and pregnancy from the patient's perspective in order to identify key themes that should be addressed in preconception counseling and psychological care for women with IBD during the reproductive period.…”

Effect of biologicals and JAK inhibitors during pregnancy on health-related outcomes in children of women with inflammatory bowel disease

“…Many women with IBD are afraid that IBD might lead to complications during pregnancy or immunosuppressive medication might harm the neonate [1]. Voluntary childlessness is increased in women with IBD and is associated with lack of knowledge of how IBD and immunosuppressive medication might influence the outcome of pregnancy and the neonate [2,3]. Women who receive preconception counselling are less likely to be voluntarily childless [3].…”

“…Voluntary childlessness is increased in women with IBD and is associated with lack of knowledge of how IBD and immunosuppressive medication might influence the outcome of pregnancy and the neonate [2,3]. Women who receive preconception counselling are less likely to be voluntarily childless [3]. Relapse of IBD has been associated with unfavourable pregnancy outcomes with an increased risk of spontaneous abortion, prematurity and low birth weight [4,5].…”