AGA working group releases guide for pregnant women with IBD
The American Gastroenterological Association has published a new clinical care pathway to develop a standardized plan among health care providers who treat women with IBD throughout all stages of family planning.
“In the United States, 1.6 million people have inflammatory bowel disease,” Rajeev Jain, MD, AGAF, FACP, an IBD Parenthood Project program co-chair and a gastroenterologist at Texas Digestive Disease Consultants, told Healio Gastroenterology and Liver Disease. “Of those, roughly half are women, and most will carry the diagnosis during childbearing years, throughout all phases of family planning – trying to conceive, pregnancy and postpartum. Additionally, the number of women with IBD who are voluntarily childless is three times greater than that of the general population, mainly because of lack of information and misperceptions around pregnancy and IBD.”
The report from the AGA’s IBD Parenthood Project Working Group was developed in partnership with the Crohn’s & Colitis Foundation, the Society for Maternal-Fetal Medicine and Girls With Guts, a patient support network. The report, according to Jain, aimed to address misperceptions about women with IBD and what providers experience in pre-conception, pregnancy and postpartum.
“This clinical pathway is unique in that many stakeholders outside of gastroenterology were involved, including maternal fetal-medicine subspecialists, patients and lactation specialists,” he said. “I believe having a patient voice in the development of this clinical pathway was truly special and valuable.”
Jain said that the creation of the care pathway represents the first clinical guidance for gastroenterologists, obstetric providers and other providers involved in the care of women with IBD during their childbearing years to ensure the optimal care of patients, leading to a healthy pregnancy and healthy baby.
The pathway recommends that gastroenterologists handle a patient’s IBD care and see the patient once during the first and second trimester, and conduct additional visits as deemed appropriate for disease severity as well as pregnancy status.
Gastroenterologists are encouraged to coordinate with a patient’s obstetric provider who, according to the pathway, should lead all pregnancy-related care. The pathway also recommends that providers offer a clear and understandable consensus plan for managing the disease during the process, as it is likely that a patient will see multiple providers during their pregnancy and could be receiving multiple medical opinions.
“Communication among these providers, as well as between any other providers involved, is very important,” Jain said.
The pathway recommends that the decision between a vaginal or cesarean delivery should focus on usual indications. A vaginal delivery is considered safe in most cases, unless the patient has active perineal disease or other unique circumstances.
The experts recommend a cesarean delivery for women with prior rectovaginal fistulas, owing to its protective effects on the prior surgical repair site, as well as higher rates of recurrent involvement of the tissue with possible incontinence in complex cases.
Additionally, caesarean should be considered in cases of perineal involvement or prior perineal surgery in an effort to prevent recurrent damage or incontinence.
Stomal problems such as displacement, enlargement, retraction, stenosis, and prolapse may occur in patients who have an ostomy. The pathway recommends that patients should work with a nutritionist if needed to avoiding gaining excessive weight during pregnancy.
Covering the ostomy with gauze is considered adequate in protecting the operative field if a cesarean delivery is required, according to the pathway.
Based on recent unpublished raw data from a survey the AGA conducted, according to Jian, more than 40% of clinicians at obstetrician/gynecologist practices who treat women with IBD felt the quality of information these patients receive about pregnancy, as it relates to their condition, is inadequate compared to patients with other immune-mediated disorders.
“The pathway creates a standardized work flow among HCPs who treat women with IBD throughout all stages of family planning,” Jain said. “It includes pertinent information about fertility, genetics, treatment, medication, remission, delivery options and overall postpartum care that providers can reference to as they communicate with their patients.” – by Ryan McDonald
For more information:
Visit the IBD Parenthood Project.
Disclosures: Jain reports conducting research with AbbVie, Genentech, Gilead, Janssen and Takeda. Please see the full study for a list of all other authors’ relevant financial disclosures.