Pierre Ellul1, Stephania Chectuti Zammita2, Konstantinos H Katsanos3, Monica Cesarini4, Mariangela Allocca5, Silvio Danese5, Pantelis Karatzas6, Sara Canora Moreno7, Uri Kopylov8, Gionata Fiorino5, Joana Torres9, Antonio Lopez-Sanroman7, Mandy Caruana2, Louise Zammit2, Gerassimos Mantzaris6. 1. Division of Gastroenterology, Mater Dei Hospital, Malta ellul.pierre@gmail.com. 2. Division of Gastroenterology, Mater Dei Hospital, Malta. 3. Department of Internal Medicine, University of Ioannina School of Medical Sciences, Ioannina, Greece. 4. Dipartimento di Medicina Interna e Specialita' Mediche, University of Rome 'Sapienza', Italy. 5. IBD Center, IRCCS Humanitas, Milan, Italy. 6. Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. 7. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 8. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel. 9. Hospital Beatriz Ângelo, Gastroenterology Department, Loures, Portugal.
Abstract
INTRODUCTION AND AIMS: As inflammatory bowel diseases [IBD] affect female patients almost exclusively during their reproductive age, issues related to fertility, fecundity, pregnancy, delivery, and lactation are of utmost importance. Lack of education and misconceptions regarding the effect of disease and/or treatment on reproductive outcome may lead to voluntary childlessness and/or development of unwanted cervical pathologies which may impact tremendously on patients' welfare and quality of life. The aims of this study were to assess the perspectives of IBD patients on fertility, pregnancy and its outcomes, and lactation, as well as their awareness of human papillomavirus [HPV]-related pathologies and screening for cervical cancer. METHODS: This prospective study was performed across nine different Mediterranean IBD centres between 2014 and 2015 and included consecutive female IBD patients between the ages of 16 and 50 years. All patients responded to a questionnaire based on ECCO guidelines. RESULTS: A total of 348 IBD female patients with a mean age of 37.4 (standard deviation [SD] ± 2.1) years were recruited; 50% had a diagnosis of ulcerative colitis, 49.4% had Crohn`s disease, and 0.6% patients had a diagnosis of indeterminate colitis [IC]. A significant proportion of patients [ > 60%] were afraid that IBD may lead to a complicated pregnancy and that the disease itself and/or its medications can cause fetal harm. Patients had similar concerns that IBD can be transmitted to their offspring as well as with regard to breastfeeding. Counselling from health care professionals with regard to fertility, pregnancy, and lactation was associated positively with the highest number of pregnancies and inversely with the lowest number of patients who considered voluntary childlessness [p < 0.0001]. Patients with a higher level of education were more likely to get pregnant [p = 0.004]. There was a low uptake of the HPV vaccine. However, there was a reasonably good uptake of cervical cancer screening. CONCLUSION: Our study demonstrates that women with IBD have misperceptions about fertility, pregnancy, and health maintenance. We also show that education by physicians has a positive influence. We thus conclude that improved multidisciplinary approaches should be used to educate and implement European guidelines for women with IBD.
INTRODUCTION AND AIMS: As inflammatory bowel diseases [IBD] affect female patients almost exclusively during their reproductive age, issues related to fertility, fecundity, pregnancy, delivery, and lactation are of utmost importance. Lack of education and misconceptions regarding the effect of disease and/or treatment on reproductive outcome may lead to voluntary childlessness and/or development of unwanted cervical pathologies which may impact tremendously on patients' welfare and quality of life. The aims of this study were to assess the perspectives of IBD patients on fertility, pregnancy and its outcomes, and lactation, as well as their awareness of human papillomavirus [HPV]-related pathologies and screening for cervical cancer. METHODS: This prospective study was performed across nine different Mediterranean IBD centres between 2014 and 2015 and included consecutive female IBD patients between the ages of 16 and 50 years. All patients responded to a questionnaire based on ECCO guidelines. RESULTS: A total of 348 IBD female patients with a mean age of 37.4 (standard deviation [SD] ± 2.1) years were recruited; 50% had a diagnosis of ulcerative colitis, 49.4% had Crohn`s disease, and 0.6% patients had a diagnosis of indeterminate colitis [IC]. A significant proportion of patients [ > 60%] were afraid that IBD may lead to a complicated pregnancy and that the disease itself and/or its medications can cause fetal harm. Patients had similar concerns that IBD can be transmitted to their offspring as well as with regard to breastfeeding. Counselling from health care professionals with regard to fertility, pregnancy, and lactation was associated positively with the highest number of pregnancies and inversely with the lowest number of patients who considered voluntary childlessness [p < 0.0001]. Patients with a higher level of education were more likely to get pregnant [p = 0.004]. There was a low uptake of the HPV vaccine. However, there was a reasonably good uptake of cervical cancer screening. CONCLUSION: Our study demonstrates that women with IBD have misperceptions about fertility, pregnancy, and health maintenance. We also show that education by physicians has a positive influence. We thus conclude that improved multidisciplinary approaches should be used to educate and implement European guidelines for women with IBD.
Authors: Ariella Bar-Gil Shitrit; Yael Cohen; Ori Hassin; Ami Ben Ya'acov; Rivkah Farkash; Benjamin Koslowsky; Yael Milgrom; Dan Meir Livovsky; Arnon Samueloff; Eran Goldin; Sorina Grisaru-Granovsky Journal: Dig Dis Sci Date: 2018-04-06 Impact factor: 3.199
Authors: Reed T Sutton; Kelsey Wierstra; Jasmin Bal; Kathleen P Ismond; Levinus A Dieleman; Brendan P Halloran; Karen I Kroeker; Richard N Fedorak; Keri-Ann Berga; Vivian W Huang Journal: J Can Assoc Gastroenterol Date: 2019-12-19