Article Text

Download PDFPDF
Original research
Provision of care for pregnant women with IBD in the UK: the current landscape
  1. Sarah Wolloff1,
  2. Emma Moore1,
  3. Tracey Glanville2,
  4. Jimmy Limdi3,4,
  5. Klaartje B Kok5,
  6. Aileen Fraser6,
  7. Alexandra Kent7,
  8. Khasia Mulgabal8,
  9. Catherine Nelson-Piercy9,
  10. Christian Selinger1
  1. 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Department of Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
  3. 3Section of IBD—Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
  4. 4Gastroenteterology, Manchester Academic Health Science Centre, Manchester, UK
  5. 5Department of Gastroenterology, Barts and The London NHS Trust, London, UK
  6. 6Department of Gastroenterology, United Hospitals Bristol, Bristol, UK
  7. 7Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
  8. 8Department of Obstetrics, Royal Bolton Foundation NHS Trust, Bolton, UK
  9. 9Department of Obstetric Medicine, Guy's and Saint Thomas' Hospitals 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

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.

  • ulcerative colitis
  • Crohn's disease
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors SW, EM, CS and TG designed the study. SW and EM performed the data collection and initial analysis. SW, EM, TG, JL, KBK, AF, AK, KM, CN-P and CS reviewed and analysed the data. CS wrote the draft manuscript. SW, EM, TG, JL, KBK, AF, AK, KM and CN-P critically reviewed the manuscript.

  • 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 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.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available. No data are available for public sharing.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.