Risk Factors for Voluntary Childlessness in Men and Women With Inflammatory Bowel Disease

Winter, Rachel; Boyd, Taylor; Chan, Walter W.; Levy, Alexander N.; Friedman, Sonia

doi:10.1093/ibd/izac104

Cited by 8 publications

(6 citation statements)

References 7 publications

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“…However, it was more common to limit the number of children born (voluntary birth restriction) than to completely refrain from having children (voluntary childlessness). As in previous studies, concerns that the disease will worsen as a result of pregnancy and concerns about the heredity of the disease appear to be important causes for voluntary childlessness and reduction of number of children born 356,359 . In this material the most common cause was concerns about sustaining a perineal tear, given the underlying UC, which is possibly explained by the fact that women post colectomy may have great fear for incontinence problems.…”

Section: Fertility In Women With Ucsupporting

confidence: 57%

“…Appropriate education on pregnancy and family planning for all patients with IBD of childbearing age is recommended to avoid decision on birth restriction on incorrect grounds 339 . It has lately been suggested that voluntary childlessness in IBD is affected by socioeconomic and demographic factors rather than the severity of IBD 359 . Association with lower educational level and financial uncertainty have been reported 358,359 .…”

Section: Voluntary Childlessness In Ibdmentioning

confidence: 99%

“…It has lately been suggested that voluntary childlessness in IBD is affected by socioeconomic and demographic factors rather than the severity of IBD 359 . Association with lower educational level and financial uncertainty have been reported 358,359 .…”

Section: Voluntary Childlessness In Ibdmentioning

confidence: 99%

“…Voluntary childlessness has been shown to be an important cause of the reduced fertility seen in women with IBD 355,356,359,443,444 , it is more commonly reported by women with CD, than UC 339,348,444 . In paper I, an increased use of contraceptives was seen both before and after diagnosis, which was interpreted as an expression of voluntary childlessness 345 .…”

Section: Fertility In Women With CDmentioning

confidence: 99%

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Fertility in Inflammatory Bowel Disease

Druvefors

2023

Linköping University Medical Dissertations

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Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce.From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964-2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000-2020 was identified.Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed.From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals.The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis.In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal pouch anal anastomosis (IPAA) and ileorectal anastomosis (IRA) was used to about the same extent in UC and IBD-U, although this was rare in CD. Compared with the matched reference cohort, women with IBD had lower fertility overall after colectomy (HR 0.65, CI 0.61-0.69), with least impact for operations that left the rectum intact (HR 0.79, CI 0.70-0.90). When the comparison was made within the group of ABSTRACT 2 patients undergoing colectomy, fertility in female patients remained nearly unaffected after IRA in all subtypes of IBD, but was impaired after IPAA, especially in UC (HR 0.67 CI 0.50-0.88), and after completion proctectomy in all subtypes of IBD (CD 0.61 CI 0.38-0.96), UC HR 0.65, CI 0.49-0.85 and IBD-U0.68, 0.55-0.85).The survey regarding reproductive behavior after colectomy was completed by 214 (73%) out of 294 eligible women identified in SWIBREG. The desire to have children was negatively affected by disease onset in 59% of the women, colectomy in 44% and by reconstruction in 37%. Altogether, 39% women with UC estimated that they chose to have fe...

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Section: Fertility In Women With Ucsupporting

confidence: 57%

Section: Voluntary Childlessness In Ibdmentioning

confidence: 99%

Section: Voluntary Childlessness In Ibdmentioning

confidence: 99%

Section: Fertility In Women With CDmentioning

confidence: 99%

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Fertility in Inflammatory Bowel Disease

Druvefors

2023

Linköping University Medical Dissertations

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“…Fertility is a concern for many IBD patients [6], although rates of infertility in inactive IBD with no previous pelvic surgery are comparable to those in the general population [7,8]. Voluntary childlessness appears to be more frequent in women with IBD [6,9], driven mainly by concerns around heritability and medication risk [8][9][10].…”

Section: Preconceptionmentioning

confidence: 99%

Conception, pregnancy and inflammatory bowel disease—Current concepts for the practising clinician

Liu,

Chatten,

Limdi

2024

Indian J Gastroenterol

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The peak incidence of inflammatory bowel disease (IBD) coincides with a woman’s prime reproductive years. The management of IBD during pregnancy can be challenging for healthcare professionals, underpinning the need for a multi-disciplinary approach with shared decision-making with the patient. Pre-conception counselling can address patient concerns, improve pregnancy specific IBD patient knowledge and provide a personalized risk assessment, to ensure optimal maternal and fetal outcomes. Most women with IBD have fertility rates comparable with the general population, although voluntary childlessness is common among women with IBD. IBD disease activity at conception and during pregnancy is a key determinant of the course of IBD during pregnancy. Active IBD during pregnancy is associated with adverse pregnancy-related outcomes, including spontaneous abortion, small for gestational age baby and preterm birth, emphasizing the importance of ensuring disease remission prior to conception. Most IBD medications (5-aminosalicylates, thiopurines if already initiated pre-conception, corticosteroids and biologic medications) are considered safe and low risk during pregnancy and breastfeeding, except for methotrexate, JAK-inhibitors, ozanimod and allopurinol and maintaining remission throughout gestation should be the priority. Most women with IBD can have a vaginal delivery, but cesarean section should be considered in active perianal disease and history of ileal pouch surgery. This narrative review outlines the current evidence for the management of IBD in pregnancy, as well as considering the pre-conceptual and post-partum period.

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