Background: The impact of a mother's chronic disease on fetal development makes dealing with inflammatory bowel disease (IBD) during pregnancy complicated. Almost 50% of women with IBD have poor reproductive knowledge; this has been associated with unsubstantiated concerns toward pregnancy, and towards IBD medications. With the help of Pixel Designs Company, we developed an educational web portal and evaluated the portal for effectiveness at improving pregnancy and medication concerns in IBD patients.
Methods: IBD patients aged 18–45 years were invited to participate in a study to evaluate the effectiveness of an educational web portal covering the topics of heritability, fertility, surgery, pregnancy outcomes, delivery, postpartum, and breastfeeding in the context of IBD and IBD medications. Patients completed pre- and post-study questionnaires about seven IBD-specific pregnancy concerns, and identified Likert scores for nine medication concerns from the Beliefs About Medicines Questionnaire (BMQ). McNemar's non-parametric test was used to determine if the proportion of patients who had each pregnancy concern decreased post-intervention. For medication concerns, Wilcoxon signed-rank test was used to compare median differences between Likert scores. P values of 0.05 were used for analysis with SPSS version 23.
Results: Seventy-eight of 111 patients (70.3%) completed pre and post-study questionnaires. Demographics for the 78 are as follows: median age 29.3 (IQR 25.6–32.9) years; 54 (69.2%) Crohn's disease; 21 (26.9%) ulcerative colitis; 63 (80.3%) females, 5 (7.9%) currently pregnant and 19 (30.2%) previously pregnant. Medication history: 10 (12.8%) sulfasalazine, 67 (85.9%) mesalamine/5-ASAs, 17 (21.8%) budesonide, 63 (80.8%) steroids, 12 (15.4%) methotrexate, 55 (70.5%) azathioprine/mercaptopurine, 42 (53.8%) biologics, and 38 (48.7%) antibiotics. The intervention significantly decreased the proportion of patients who reported reproductive concerns regarding: fertility, added stress of raising a child affecting IBD, birth defects from IBD, pregnancy causing a flare-up, and inability to breastfeed due to IBD or medications. The BMQ Likert scores significantly decreased post intervention for concerns about having to take IBD medication, becoming too dependent on IBD medication, and the long-term effects of IBD medication.
Conclusions: Our educational web portal reduces the proportion of patients who report certain concerns about pregnancy in IBD, in addition to concerns regarding their IBD medications.