{"id":1882,"date":"2020-03-08T09:57:32","date_gmt":"2020-03-08T09:57:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=1882"},"modified":"2020-03-08T10:22:15","modified_gmt":"2020-03-08T10:22:15","slug":"the-importance-of-pre-conceptual-and-pregnancy-care-in-inflammatory-bowel-disease","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2020\/03\/08\/the-importance-of-pre-conceptual-and-pregnancy-care-in-inflammatory-bowel-disease\/","title":{"rendered":"The importance of pre-conceptual and pregnancy care in Inflammatory Bowel Disease"},"content":{"rendered":"

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This week’s blog comes from Helen Janiszewski, a midwife from Nottingham University Hospital NHS Trust, Nottingham Local Maternity and Neonatal System and Doctoral Researcher at Coventry University.<\/p>\n

The importance of good preconceptual care cannot be underestimated. In women with IBD it is important to help educate women who are trying to conceive about the potential implications their IBD may have on their pregnancy.<\/p>\n

Inflammatory Bowel Disease is an umbrella term for a chronic disease encompassing two main conditions: Crohn\u2019s disease and Ulcerative Colitis.\u00a0 Symptoms may include diarrhoea, rectal bleeding abdominal pain, loss of appetite, anaemia, general fatigue, tiredness with a remission and relapse cycle1<\/sup>.\u00a0 IBD is a long-term condition, with approximately 146,000 people living with Ulcerative Colitis2<\/sup> and 115,00 people living with Crohn\u2019s disease in the United Kingdom3<\/sup>.<\/p>\n

As the peak incidence of IBD is between 15-30 years of age with approximately 50% of people being diagnosed with IBD before they are 35 years old, diagnosis can impact women at the time when fertility and pregnancy are high on the agenda4<\/sup>.\u00a0 The cause of IBD is still unknown, and the reason for this peak age of onset also remains equally unclear.\u00a0 Women with IBD have a similar fertility rate (have as many children) to that of the general population unless they have had pelvic surgery, which can sadly decrease their rate of conception5<\/sup>; or if chronic disease activity leads to malnutrition.\u00a0 Approximately 25% of women will become pregnant following their diagnosis of IBD4<\/sup>; and possibly during pregnancy. Healthcare professionals should be IBD aware when women who present with symptoms in pregnancy. Symptoms including rectal bleeding and fatigue may be mis-attributed to common pregnancy ailments but could also be indicators of IBD, and warrant further investigation6<\/sup>.<\/p>\n

The additional risk of pregnancy complications may also affect women\u2019s emotional wellbeing, through additional worry and concerns during their pregnancy and implications of medication on pregnancy and breastfeeding.\u00a0 Disease activity at conception may be a good predictor of how symptoms will be during pregnancy, and therefore the risk of pregnancy complications for the mother and the fetus\/baby7<\/sup>.<\/p>\n

Severe disease activity during pregnancy further increasing the risk of pregnancy complications including8,9,10,11<\/sup>:<\/p>\n