AGA Outlines Care Pathway for Pregnant Women With IBD
Gastroenterologists and maternal-fetal medicine subspecialists should play a role in caring for pregnant women with inflammatory bowel disease (IBD), according to a new set of guidelines from the American Gastroenterological Association (AGA).1
This recommendation is part of a new set of guidelines created through a collaboration with the Crohn's & Colitis Foundation, the Society for Maternal-Fetal Medicine, and the patient support network Girls With Guts.
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The guidelines set a standardized clinical care pathway for health care providers who treat women with IBD at all stages of family planning,2 and are indicative of a recent AGA survey that reported more than 40% of clinicians at OB/GYN practices who treat women with IBD feel that the quality of information their patients receive about IBD in pregnancy is inadequate compared to patients with other immune-mediated disorders.
In the guidelines, the AGA recommends that a gastroenterologist who is an expert in IBD coordinate the IBD care for patients with IBD and regularly see them throughout their pregnancy. This should be done in close collaboration with the patient’s maternal-fetal medicine subspecialist, who has expertise in high-risk pregnancies and can determine the type of monitoring needed and frequency of prenatal visits with an obstetric provider.
For patients who do not have access to an IBD expert and a maternal-fetal medicine specialist, the guidelines recommend that a gastroenterologist, obstetrician/gynecologist (OB/GYN), or specialized physician assistant, nurse practitioner, or midwife follow the care pathway to optimize the patients’ outcomes.
The guidelines also suggest that gastroenterologists make preconception planning a regular part of their appointments with patients who do not have access to an IBD expert and a maternal-fetal medicine specialist—even if the patient is unsure of her future family plans.
Health care providers should also work with their patients after pregnancy to maintain remission of IBD flares they may have experienced during pregnancy.
"Understanding the impact of inflammatory bowel disease throughout all stages of pregnancy can help practitioners and patients develop a plan to achieve the best outcome and reduce complications,” said Dr Rajeev Jain, AGA spokesperson. “Family planning should be on the gastroenterologist and obstetric provider, utilizing tools and resources, such as a discussion guide, whenever they see an inflammatory bowel disease patient of childbearing age."2
—Colleen Murphy
References:
1. Mahadevan U, Robinson C, Bernasko N, et al. Inflammatory bowel disease (IBD) in pregnancy clinical care pathway – a report from the American Gastroenterological Association IBD Parenthood Project Working Group [published online January 15, 2019]. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.12.022.
2. AGA releases guide to care for women with IBD throughout family planning [press release]. Bethesda, MD: American Gastroenterological Association; January 16, 2019. https://www.gastro.org/press-release/aga-releases-guide-to-care-for-women-with-ibd-throughout-family-planning. Accessed January 17, 2019.
