Voluntary Childlessness and Knowledge of Pregnancy-Related Issues in Inflammatory Bowel Disease Patients
M Boyle, F Jones, S. Murphy, P MacMathuna, J Leyden, HE Mulcahy, GA Doherty, Garret Cullen
1. Centre for Colorectal Disease, St. Vincent’s University Hospital. 2. GI Unit, Mater Misericordiae University Hospital. 3.School of Medicine and Medical Science, University College Dublin
36% of women with IBD choose not to have children (‘voluntary childlessness’) compared with reported ranges of 2.5% to 28% in the general population. Studies suggest this is because of concerns related to medication-associated teratogenicity, the impact of pregnancy on their disease, and inheritance fears. Many of these concerns are unsubstantiated because women with IBD, in general, have similar fertility to the general population, and are able to carry successful pregnancies.
To examine IBD-specific reproductive knowledge and its association with reproductive decisions, including voluntary childlessness. The secondary objectives were to examine commonly held perspectives held by women regarding IBD and pregnancy related issues.
A cross-sectional descriptive study was conducted in specialist IBD clinics. Data were gathered from a 60 item questionnaire offered to female IBD patients (age 18-60years). The Crohn's and Colitis Pregnancy Knowledge Score (CCPKNOW), a validated multiple-choice questionnaire on the subject of IBD that is able to objectively quantify the level of patient knowledge was employed. Scores were grouped according to; poor (0 to 7); adequate (8 to 13); very good (14 to 17).
102 women took part in this study (Median age 35.5 years (IQR 15.5), 60%UC; 52% were employed; 65% had completed third level education; 71% were in a relationship; 61% practiced religion). The median CCPKnow score was 5.5(IQR 8). 11% of women believed they had decreased fertility due to IBD; 15% were concerned regarding birth defects, and 17% were afraid of a disease flare in pregnancy. Despite this, almost half (48%) did not seek pregnancy advice. 67% of the cohort had children. Of the 34 women without children; 8 women were ‘voluntarily childless’ (24%). In this group; the median age was 39.5 years (IQR 6). 28% of subjects indicated their disease changed their attitudes toward childbearing, but two-thirds (62%) said they would have children irrespective of their diagnosis. One third of women who had children after a diagnosis of IBD stated they would have no further as a result of their disease.
The overall level knowledge of pregnancy issues specific to IBD was low in this cohort. 24% of women without children were ‘voluntarily childless’ at a median age of 39 years, compared to 17% in the general population at age 40. The use of CCPKnow as an educational screening tool for female IBD patients of childbearing age may allow targeted patient education on pregnancy related issues.