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. 2022 Mar 23;22(1):238.
doi: 10.1186/s12884-022-04560-y.

Facilitators and barriers of preconception care in women with inflammatory bowel disease and rheumatic diseases: an explorative survey study in a secondary and tertiary hospital

L A C Admiraal  1 , A N Rosman  2 , R J E M Dolhain  3 , R L West  4 , A G M G J Mulders  5
Affiliations

Facilitators and barriers of preconception care in women with inflammatory bowel disease and rheumatic diseases: an explorative survey study in a secondary and tertiary hospital

L A C Admiraal et al. BMC Pregnancy Childbirth. .

Abstract

Background: Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.

Methods: An explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy (< 1 year ago) visiting the outpatient clinic of a secondary and tertiary hospital and involved physicians and obstetric professionals were eligible.

Results: A total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively.

Conclusion: Lack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.

Keywords: Chronic inflammatory disease; Inflammatory bowel disease; Obstetrics; Preconception care; Rheumatic diseases.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Healthcare professionals’ point of view: professionals suitable for PCC in women with IBD/RD. The profession of the healthcare professionals included in the answer to this question, depicted at the bottom of the figure, are respectively a gynecologist, a disease specialist, a midwife and a general practitioner. Ranking was performed according to a 5-point scale from ‘most certainly’ to ‘most certainly not’. Percentages were calculated based on number of respondents who filled in: ‘most certainly’ and ‘certainly’. The percentages reflect the suitability of the professional to provide PCC to women with IBD/RD according to the healthcare professionals, reflected as respondents, from respectively the department of Gastroenterology (dark blue), department of Rheumatology (blue) and department of Obstetrics and Gynecology (light blue)
See this image and copyright information in PMC

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