A Multidisciplinary Approach Can Inform Patients With IBD About Fertility

A multidisciplinary approach should be used to help educate women with inflammatory bowel disease (IBD) about fertility and how disease impacts their childbearing, according to a Keynote presentation by Dr Marla Dubinsky at the 2018 AIBD Meeting.

Studying the impact of IBD on fertility is important because the peak incidence of IBD overlaps childbearing years, the impact of disease activity and IBD medications on fertility and pregnancy outcomes is a concern to the patients and the physician, and the impact of disease on sexual and relationship health is an important aspect of overall disease management.

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However, currently, most decisions made surrounding pregnancy and fertility are based on a lack of knowledge, Dubinsky, who is the chief of pediatric gastroenterology and nutrition at Icahn School of Medicine, co-director of the Susan and Leonard Feinstein IBD Clinical Center, and director of IBD Preconception and Pregnancy Planning Clinic at Mount Sinai Hospital, said during her presentation.

“We have a perception problem when it comes to childbearing and IBD, particularly concerns about safety of therapies and fear of passing disease onto the child,” Dubinsky said.

Common fears and perceptions about reproductive health and IBD include:

• IBD will cause harm to the baby;
• IBD medications will cause harm to the baby;
• passing of disease to their baby;
• having a complicated pregnancy; and
• not being able to care for the baby.

Dubinsky said patients often prioritize their questions about their disease and their decisions on where they are in preconception of pregnancy.

“It’s also not surprising most concerns in preconception surrounds the idea of being on medications and how it will hurt the baby,” she said. “It’s a great opportunity for physicians to help relieve fears of influence of disease.”

Dubinsky said despite the perceptions and fears, elective abortions are not increased among women with IBD. Elective abortions are more common in the clinical trial setting, when a woman becomes pregnant within the first few weeks of the trial.

Studies have shown patients often aren’t educated enough to make decisions on what they should do in terms of getting pregnant. Patient often choose not to get pregnant because they don’t know they can.

“[The studies suggest] maybe if we give them the knowledge before, keep them on their medications, and instill in them to not stop their medications then we can have a better impact on disease activity which will help the whole cascade of getting pregnant and staying pregnant,” Dubinsky said.

Seeing patients and starting the conversation early, even among young women just going off to college, is important.

“They want to talk about it,” Dubinsky said.

Dubinsky said a multidisciplinary team consisting of the patient and partner, GI doctor with IBD and fertility expertise, OB/GYN, fertility specialist, and a colorectal surgeon should all be involved in the conversation.

“There is an important team that has to be in place to manage these important topics,” she said.

Reference:

Dubinsky M. IBD and fertility: How will my disease and my treatments affect my ability to have children? Presented at: Advances in Inflammatory Bowel Diseases; December 13-15, 2018; Orlando, FL. https://www.consultant360.com/meetings/aibd.