P009 INFREQUENT COUNSELING BY PHYSICIANS ON IBD AND REPRODUCTIVE HEALTH ISSUES REPORTED BY PATIENTS IN CONJUNCTION WITH LOW CCPKNOW KNOWLEDGE SCORES IN AN EDUCATED COHORT. (7th February 2019) - Rao, Aarti
Abstract: Background: IBD and reproductive health counseling (IBD-RHC) is associated with higher knowledge, lower voluntary childlessness and greater medication adherence during pregnancy. Yet prior studies show documentation of IBD-RHC is low in both women and men, and few patients are satisfied with advice received on family planning and pregnancy. Aims: 1. Quantify rates of IBD-RHC. 2. Investigate factors associated with IBD-RHC. 3. Assess knowledge and interest in further education on IBD and reproductive health. Methods: We anonymously surveyed women and men ages 18-45 with IBD over a 6-month period in 2018 regarding their reproductive health histories and education experiences. We administered the CCPKnow questionnaire to assess IBD and reproductive health knowledge. STATA was used to summarize descriptive statistics and compare categorical variables using Fisher's exact test. Results: Sixty-six patients (58% F) completed the survey and the majority (85%) had at least a college degree. Only 30% of all patients and 18% of patients with IBD surgery reported prior reproductive health counseling by a physician (Table 1). Both men and women considered not having a child due to IBD (34% F, 18% M). The majority (83%) who considered voluntary childlessness did not receive prior IBD-RHC. Less than half (42%) of women had at least an adequate (≥8/17) CCPKnow score. Of the 11 women with an IBD diagnosis before pregnancy, 82% had no prior IBD-RHC, 60% did not seek GI care pre-conception and 36% did not seek GI care during pregnancy, yet 36% reported flares in the pre-conception, pregnancy or postpartum period. Additionally, 50% stopped or changed medications during pregnancy and 40% did so without consulting a physician. Patients reporting current immunomodulator use were more likely to have reported prior IBD-RHC (50% vs 22%, p=0.04, Table 2). Overall 71% of people reported interest in receiving more information on IBD and reproductive health. Discussion: In an educated cohort at a tertiary care center, patients reported low rates (30%) of IBD-RHC on heritability, fertility and medication safety. Rates were lower (<20%) in patients who considered not having children due to IBD and those diagnosed with IBD prior to pregnancy. Current immunomodulator use was significantly associated with prior IBD-RHC, suggesting that counseling is provided on medications with negative effects on fertility (i.e. methotrexate) but not on the importance of pre-conception care and medication adherence. The majority of patients pregnant after an IBD diagnosis did not seek GI care pre-conception and many stopped or changed medications during pregnancy without consulting a physician. This highlights an urgent need for proactive counseling by gastroenterologists on IBD and reproductive health issues, supported by the majority of patients (71%) expressing a need for more education on these topics.