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. 2020 Aug 26;12(6):487-492.
doi: 10.1136/flgastro-2020-101546. eCollection 2021.

Provision of care for pregnant women with IBD in the UK: the current landscape

Sarah Wolloff  1 , Emma Moore  1 , Tracey Glanville  2 , Jimmy Limdi  3   4 , Klaartje B Kok  5 , Aileen Fraser  6 , Alexandra Kent  7 , Khasia Mulgabal  8 , Catherine Nelson-Piercy  9 , Christian Selinger  1
Affiliations

Provision of care for pregnant women with IBD in the UK: the current landscape

Sarah Wolloff et al. Frontline Gastroenterol. .

Abstract

Introduction: Suboptimal control of inflammatory bowel disease (IBD) can result in increased rates of adverse pregnancy-related outcomes. We aimed to describe the current landscape of provision of antenatal care for women with IBD in the UK.

Methods: This cross-sectional survey collected data on service setup; principles of care pre-conception, during pregnancy and post partum; and on perceived roles and responsibilities of relevant clinicians.

Results: Data were provided for 97 IBD units. Prepregnancy counselling was offered mostly on request only (54%) and in an ad hoc manner. In 86% of units, IBD antenatal care was provided by the patient's usual gastroenterologist, rather than a gastroenterologist with expertise in pregnancy (14%). Combined clinics with obstetricians and gastroenterologists were offered in 14% of units (24% academic vs 7% district hospitals; p=0.043). Communication with obstetrics was 'as and when required' in 51% and 30% of IBD units reviewed pregnant women with IBD 'only when required'. The majority of respondents thought gastroenterologists should be involved in decisions regarding routine vaccinations (70%), breast feeding (80%), folic acid dosage (61%) and venous thromboembolism (VTE) prophylaxis (53%). Sixty-five per cent of respondents thought that gastroenterologists should be involved in decisions around mode of delivery and 30% recommended caesarean sections for previous but healed perianal disease.

Conclusions: This nationwide survey found considerable variation in IBD antenatal services. We identified deficiencies in service setup, care provided by IBD units and clinician knowledge. A basic framework to inform service setup, and better education on the available clinical guidance, is required to ensure consistent high-quality multidisciplinary care.

Keywords: Crohn's disease; ulcerative colitis.

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Conflict of interest statement

Competing interests: CS has received unrestricted research grants from Warner Chilcott, Janssen and AbbVie, has provided consultancy to Warner Chilcott, Dr Falk, AbbVie, Takeda, Fresenius Kabi and Janssen, and had speaker arrangements with Warner Chilcott, Dr Falk, AbbVie, MSD, Pfizer and Takeda.CN-P had speaker arrangements with Dr Falk, UCB, Sanofi, Alliance and Alexion. KBK has provided consultancy to Amgen and PredictImmune, and had speaker arrangements with Janssen and Takeda. AK has provided consultancy to AbbVie, and had speaker arrangements with Pfizer, Janssen and Takeda. JL has received research grants from AbbVie and Takeda, has provided consultancy to AbbVie, Janssen, Pfizer, Viforpharma and Takeda and had speaker arrangements with AbbVie, MSD, Janssen, Pfizer and Takeda. All other authors do not declare any conflict of interest.

Figures

Figure 1
Figure 1
The decision-making responsibilities of different specialties. A bar chart indicating which specialities respondents thought were responsible for decision making/offering advice on delivery method, IBD medication, routine vaccinations for the infant and breast feeding. IBD, inflammatory bowel disease.
See this image and copyright information in PMC

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