Woodhams, Elisabeth J.

Abstract Background and Aims Active inflammatory bowel disease (IBD) at conception is associated with adverse pregnancy outcomes. International guidelines address antenatal care, but contraception counseling and risk assessment are not addressed. Data on healthcare professionals’ guidance for women with IBD regarding contraception are scarce. We aimed to describe contraceptive use, preferences, knowledge, and barriers among women with IBD. Methods A 34-item questionnaire was administered to female IBD patients aged 18-45. Disease control was measured using PRO-2 and IBD-control questionnaire, and contraceptive preferences were assessed by the contraceptive features survey. Logistic regression explored associations between contraceptive use, attitudes, disease remission status, and other factors. Results Of 338 women surveyed, 243 (74%) used some form of contraception. Oral birth control pills (28%) and barrier methods (18%) were most used but 20% used long-acting methods. Women with active disease were more likely to use long-acting contraception (23%) compared to those in remission (17%). Contraceptive priorities were effectiveness (78%), ease of use (75%), and minimal side effects (68%). Only 25% women had discussed reproductive issues with their IBD clinician, though 85% were comfortable to do so. Preferred sources for reproductive counseling were IBD nurses (79%), general practitioners (75%), IBD doctors (68%), and gynecologists (49%). Conclusions A quarter of women with IBD were not using any contraception, and long-acting contraceptive use was low. Women prefer effective, easy-to-use contraceptives with minimal side effects but lack knowledge on effective contraception-related issues. Better education and proactive discussions between healthcare providers and patients could improve reproductive health in women with IBD.

Abstract Background Active inflammatory bowel disease (IBD) at conception is associated with adverse pregnancy outcomes. Published literature suggests that almost a quarter of women with IBD do not use any form of contraception putting them at risk of unplanned pregnancy. Recent guidelines emphasise the importance of antenatal care in IBD patients, but contraception counselling and risk assessment are not addressed. Our aim was to explore the contraceptive knowledge, attitudes and preferences of women with IBD. Methods A 34-item questionnaire was prospectively administered to 245 consecutive female IBD patients aged 18–45 attending gastroenterology clinics. Disease control was measured using the validated IBD Control questionnaire, and contraceptive preferences assessed by the Contraceptive Features Survey. Results Of the 245 participants (see table 1), mean disease duration was 6.5 years, median IBD control score was 16.9 (range 0- 26), and 152 (62%) respondents had previously been pregnant. Almost three quarters of respondents (n=176) reported currently using contraception, and 41 (17%) were using highly effective contraceptives. The most commonly used contraceptives were oral birth control pills (27%) and barrier methods (18%). Participants who identified as Caucasian (74%) were more likely than those who identified as Asian (37%) to use contraception (p=0.0009). Patients who did not plan to conceive in the future were more likely to use contraception (p=0.0365). However, of the 58% (n=143) who had either no plans to conceive in the future or were unsure, 23% were not using any form of contraception, and 83% were not using a highly effective contraceptive. Current biologic therapy was significantly associated with highly effective contraceptive use (p=0.0275). Contraceptive features most important to women were effectiveness (78%), ease of use (76%), few or no side effects (68%) and not detracting from sexual enjoyment (65%). Only 25% patients (n=61) recalled discussing reproductive issues with their IBD clinician, however, 86% stated they would feel comfortable having this discussion. Women wished to receive family planning counselling from their IBD nurse (81%), General practitioner (77%), IBD doctor (68%), and gynaecologist (47%). Conclusion A quarter of patients in our cohort were not using any contraception and the majority were not using a highly effective form potentially increasing their risk of unplanned or mistimed pregnancy. Participants desired a contraceptive that was effective, easy to use and with minimal side effects. Our findings reflect the need for further studies to improve informed decision making with contraceptive counselling, to improve the overall quality of care for women with IBD.

Abstract Background Oral contraceptive pill (OCP) use in the general population is associated with a failure rate as low as 0.3% with perfect use but as high as 9% with typical use. Women with Crohn’s disease (CD) may have malabsorption in the setting of small bowel disease or resection, which could affect absorption of OCPs. Our aim was to determine the incidence of pregnancy in women with CD on OCPs. Methods This is a retrospective study assessing the incidence rate of OCP failure in females between 18 and 45 years of age seen at the Mayo Clinic with a diagnosis of CD and provided a prescription for OCPs, between 2016 and 2020. Failure was defined as clear documentation of becoming pregnant while using OCPs or having an active prescription of OCP at the time of conception. Results A total of 818 female patients with CD between 18 and 45 years of age with a prescription for an OCP were included in our study. Sixty-six patients (8%) conceived in this cohort. Of the 66 patients who became pregnant, 57 stopped the OCP before conceiving, 5 were excluded due to lack of data, and 4 women had active oral contraceptive prescriptions when they became pregnant (pregnancy rate of 0.5%). Conclusions In female patients with CD who are using OCPs for contraception, we found a low rate of pregnancy (0.5%) similar to the rate of pregnancy with perfect use of OCPs in the general population. OCPs are an effective method of birth control in women with CD.