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Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society
  1. Christian Selinger1,
  2. Nicola Carey1,
  3. Shelley Cassere2,
  4. Catherine Nelson-Piercy3,
  5. Aileen Fraser4,
  6. Veronica Hall5,
  7. Kate Harding6,
  8. Jimmy Limdi7,8,
  9. Lyn Smith9,
  10. Marie Smith10,
  11. Melanie Catherine Gunn11,
  12. Aarthi Mohan12,
  13. Khasia Mulgabal13,
  14. Alexandra Kent14,
  15. Klaartje Bel Kok15,
  16. Tracey Glanville2
  1. 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Obstetric Medicine, Guy’s and Saint Thomas’ Hospitals NHS Trust, London, UK
  4. 4Gastroenterology, United Hospitals Bristol, Bristol, UK
  5. 5Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
  6. 6Obstetrics, Guy’s and Saint Thomas’ Hospitals NHS Trust, London, UK
  7. 7Section of IBD—Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
  8. 8Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
  9. 9Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
  10. 10Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  11. 11Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  12. 12Obstetrics, United Hospitals Bristol, Bristol, UK
  13. 13Obstetrics, Royal Bolton Foundation NHS Trust, Bolton, UK
  14. 14Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
  15. 15Gastroenterology, Barts and The London NHS Trust, London, UK
  1. Correspondence to Dr Christian Selinger, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; christian.selinger{at}web.de

Abstract

Background Pregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD.

Aim To develop a position statement on service set-up and minimum standards of care in the UK.

Methods A working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters’ feedback after each round. Statements with ≥80% agreement were accepted.

Results All 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended.

Conclusion Position statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.

  • ulcerative colitis
  • Crohn's disease
  • inflammatory bowel disease
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Footnotes

  • Contributors All authors developed the guidance statements by contributing to face-to-face discussion on the guidance statement, formulating the statements and voting on the statements. The draft article was written by CS. NC, SC, CN-P, AF, VH, KH, JL, LS, MS, MCG, AM, KM, AK, KBK and TG critically reviewed the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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 Takeda, consultancy and speaker fees from Abbvie, Janssen, MSD, Pfizer and Takeda. All other authors do not declare any conflict of interest. No funding was received for this work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. There are no data beyond the published data in the manuscript.

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