Identifying Patient Priorities for Preconception and Pregnancy Counseling in IBD

Background Inflammatory bowel disease (IBD) commonly affects women of reproductive age. Many patients lacking knowledge about IBD and reproduction make uninformed decisions, such as voluntary childlessness and medication cessation. Education should be individualized to the patient's knowledge base and include topics of most importance to the patient. Our study aimed to describe the priority rankings of topics selected by patients seeking preconception and pregnancy counseling. Methods As part of an ongoing prospective study, patients with IBD were asked to rank, in order of importance, nine a priori preconception, pregnancy, and postpartum topics they would like addressed by our specialized care team, which includes an IBD physician and a high-risk obstetrician.chi(2)and Fisher's exact tests were used to assess associations between clinical and demographic characteristics and priority rankings, and apvalue cutoff for significance was set as .05. Results One hundred and fifty-eight women with IBD (mean (IQR) age; 32 (28-37) years) were seen in consultation, and 116 (70 (60%) CD, 43 (37%) UC, and 3 (3%) IBD-U) completed intake forms were analyzed. There were 78 (68%) women seen in the preconception stage, median age 31 (IQR 28-34), and 38 women (32%) were pregnant, median age 32 (IQR 28-33).Safety of IBD medications during pregnancywas most commonly ranked as top priority (40%) for all patients regardless of pregnancy status, followed bycontrol of IBD disease activity and impact on pregnancy(31%),impact of IBD and surgery on fertility(19%),pregnancy outcomes for the baby(18%),mode of delivery(6%),inheritance of IBD(4%),breastfeeding(2%),nutritional health(2%), andvaccines and newborn care(1%).The impact of IBD and surgery on fertilitywas ranked as the number one priority more often in the preconception group (pvalue < 0.01) andmode of deliveryin the pregnancy group (pvalue 0.04). Conclusion:Safety of IBD medicationsremains a priority topic for patients seeking preconception and pregnancy counseling.

Automated summary

Most IBD patients seeking preconception and pregnancy counseling prioritize the safety of IBD medications, followed by controlling disease activity and the impact on pregnancy, as well as fertility concerns related to IBD and surgery.