Robert Rhodes1, Zachary Smith1, Jaymes Adams1, Julie Stoner1, Tauseef Ali1. 1. Mr Rhodes and Mr Smith are medical students at the University of Oklahoma College of Medicine and the University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma. Mr Adams is a graduate research assistant and Dr Stoner is a professor and the chair of the Department of Biostatistics and Epidemiology at the University of Oklahoma Health Sciences Center. Dr Ali is an assistant professor of medicine in the Section of Digestive Diseases and Nutrition at the University of Oklahoma Health Sciences Center.
Abstract
UNLABELLED: Many female patients with inflammatory bowel disease (IBD) are affected during their reproductive years, and the benefits of continuing medical therapy to maintain remission during pregnancy generally outweigh the risks of therapy cessation. Knowledge of the current guidelines is important to maximize maternal and fetal outcomes. METHODS: A total of 116 practitioners (family medicine [FM], n = 35; internal medicine [IM], n = 22; obstetrics/gynecol-ogy [Ob/Gyn], n=23; gastroenterology [GI], n = 36) responded to a survey. Respondents were asked about the US Food and Drug Administration classifications of common IBD drugs, the need for caution when administering live vaccines to neonates exposed to biologic agents in utero, and 2 scenarios of patients with IBD who wanted to become pregnant. RESULTS: Compared with GI physicians, FM + IM physicians were less likely to correctly identify infliximab (Remicade, Janssen Biotech) as a pregnancy category B drug (67% vs 30%; P=.0005). Among all respondents, 38% were unaware of the need to delay administration of live vaccines to infants exposed to anti-tumor necrosis factor agents in utero. GI specialists were more likely to advise patients to continue their IBD regimen (biologic agents and thiopurines) during pregnancy than non-GI (IM, FM, and Ob/Gyn) physicians (biologic agents: 86% vs 46%; P<.0001 and thiopurines: 69% vs 15%; P<.0001). Overall, 78% of non-GI physicians said that they would change their practice based on the survey. CONCLUSION: Practitioners caring for pregnant patients may lack awareness regarding the safety and management of IBD drugs during pregnancy. Bringing awareness through education may increase the number of physicians following best practice guidelines.
UNLABELLED: Many female patients with inflammatory bowel disease (IBD) are affected during their reproductive years, and the benefits of continuing medical therapy to maintain remission during pregnancy generally outweigh the risks of therapy cessation. Knowledge of the current guidelines is important to maximize maternal and fetal outcomes. METHODS: A total of 116 practitioners (family medicine [FM], n = 35; internal medicine [IM], n = 22; obstetrics/gynecol-ogy [Ob/Gyn], n=23; gastroenterology [GI], n = 36) responded to a survey. Respondents were asked about the US Food and Drug Administration classifications of common IBD drugs, the need for caution when administering live vaccines to neonates exposed to biologic agents in utero, and 2 scenarios of patients with IBD who wanted to become pregnant. RESULTS: Compared with GI physicians, FM + IM physicians were less likely to correctly identify infliximab (Remicade, Janssen Biotech) as a pregnancy category B drug (67% vs 30%; P=.0005). Among all respondents, 38% were unaware of the need to delay administration of live vaccines to infants exposed to anti-tumornecrosis factor agents in utero. GI specialists were more likely to advise patients to continue their IBD regimen (biologic agents and thiopurines) during pregnancy than non-GI (IM, FM, and Ob/Gyn) physicians (biologic agents: 86% vs 46%; P<.0001 and thiopurines: 69% vs 15%; P<.0001). Overall, 78% of non-GI physicians said that they would change their practice based on the survey. CONCLUSION: Practitioners caring for pregnant patients may lack awareness regarding the safety and management of IBD drugs during pregnancy. Bringing awareness through education may increase the number of physicians following best practice guidelines.
Authors: Fabian Schnitzler; Herma Fidder; Marc Ferrante; Vera Ballet; Maja Noman; Gert Van Assche; Bernard Spitz; Ilse Hoffman; Kristel Van Steen; Séverine Vermeire; Paul Rutgeerts Journal: Inflamm Bowel Dis Date: 2011-01-06 Impact factor: 5.325
Authors: Séverine Vermeire; Franck Carbonnel; Pierre G Coulie; Vincent Geenen; Johanna M W Hazes; Pierre L Masson; Filip De Keyser; Edouard Louis Journal: J Crohns Colitis Date: 2012-05-16 Impact factor: 9.071
Authors: J D Feuerstein; M Akbari; A E Gifford; G Cullen; D A Leffler; S G Sheth; A S Cheifetz Journal: Aliment Pharmacol Ther Date: 2013-04-02 Impact factor: 8.171