Knowledge and attitudes towards pregnancy in females with Inflammatory BowelDisease - an international, multi-centre study

Laube R1,2, Yau Y1, Selinger CP3, Seow CH4, Thomas A1, Wei Chuah S5, Hilmi I6, Mao R7,8, Ong D9, Ng SC10, Wei SC11, Banerjee R12, Ahuja V13, Alharbi O14, Leong RW1. J Crohns Colitis. 2020 Mar 11. pii: jjaa047. doi: 10.1093/ecco-jcc/jjaa047. [Epub ahead of print]


Author information

1 Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia.

2 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

3 Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

4 Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.

5 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.

6 Division of Gastroenterology and Director of Endoscopy, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

7 Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

8 Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Ohio, USA.

9 Division of Gastroenterology and Hepatology, National University Hospital System, Singapore.

10 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.

11 Department of Internal Medicine, National Taiwan University Hospital, Taiwan.

12 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

13 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

14 King Saud University, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.


BACKGROUND AND AIMS: Poor inflammatory bowel disease (IBD) pregnancy knowledge underlies unwarranted voluntary childlessness (VC), risks poorer obstetric outcomes and adverse foetal outcomes. IBD is increasing worldwide but education on IBD issues might be heterogeneous based on cultural differences and variations in models of care.

METHODS: Consecutive female IBD subjects aged 18-45 years were prospectively recruited from two dedicated IBD-pregnancy clinics, two multidisciplinary IBD clinics and nine general gastroenterology clinics. Subjects completed the validated CCPKnow (score 0-17) with questions on demographics, medical history and pregnancy knowledge. The primary outcome was knowledge per clinic-type and per-geographical region.

RESULTS: Surveys were completed by 717 subjects from thirteen hospitals across ten countries. Dedicated IBD-pregnancy clinics had the highest knowledge, followed by multidisciplinary IBD clinics then general IBD clinics (median CCPKnow 10.0 [IQR:8.0-11.0], 8.0 [IQR:5.0-10.5], 4.0 [IQR:2.0-6.0]; P<0.001). The median CCPKnow in Western, Asian and Middle Eastern clinics were 9.0, 5.0, 3.0 respectively (P<0.001). Dedicated IBD-pregnancy clinics, IBD support organisation membership, childbearing after IBD diagnosis and employment independently predicted greater knowledge. Patient perception of disease severity (r=-0.18, P<0.01) and consideration of VC (r=-0.89, P=0.031) negatively correlated with CCPKnow score.

CONCLUSIONS: In this large international study we identified predictors of pregnancy-specific IBD knowledge. Dedicated IBD-pregnancy clinics had the greatest IBD-related pregnancy knowledge and lowest VC rates, reflecting the benefits of pre-conception counselling.

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