Full Title: "Hopes, Worries and Expectations" Experiences of Pregnancy with Inflammatory Bowel Disease: An Interpretative Phenomenological Analysis Study

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Jun 13

PMID 38868041

Authors

Rebecca Homer-Perry

Wladyslawa Czuber-Dochan

Tiffany Wade

Satvinder Purewal

Sarah Ce Chapman

Matthew Brookes

Christian P Selinger

Helen Steed

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Inflammatory Bowel Disease (IBD) affects many women of childbearing age. High levels of voluntary childlessness and high levels of pregnancy-related fears have been reported amongst these patients in several quantitative studies. We investigated the lived experiences of pregnant patients to better understand decision-making processes around family planning.

Methods: Nine participants between 7 and 34 weeks pregnant (6 Crohn's Disease/3 Ulcerative Colitis), with an age range of 22-39 were recruited prospectively from three United Kingdom hospitals. Semi-structured interviews were conducted, and audio recorded. Interpretative phenomenological analysis was used to interpret the data.

Results: Two main themes emerged: 1) IBD is perceived as a threat to family planning; and 2) healthcare professional advice, support, and reassurance was important. IBD was viewed as a potential threat to fertility and reproductive health. Consequently, women's lived experience of pregnancy is shaped by anxiety and pregnancy-related worries for mother and baby. Mothers actively sought out expert medical assurances to alleviate some of the perceived fears.

Conclusion: Previous research has repeatedly found that women with IBD exhibit high levels of pregnancy-related worries and anxieties. Our findings find that high levels of anxiety are due to patients' perceptions that IBD is a threat to their reproductive health and their offspring. Women relied on a medicalized discourse to understand their IBD experiences during pregnancy and actively sought biomedical resources for assistance before and during pregnancy. Consultants should be aware that when dealing with pregnant patients, some women may experience anxiety and require extra support.

References

Gallinger Z, Rumman A, Nguyen G . Perceptions and Attitudes Towards Medication Adherence during Pregnancy in Inflammatory Bowel Disease. J Crohns Colitis. 2016; 10(8):892-7. DOI: 10.1093/ecco-jcc/jjw052. View

Selinger C, Ghorayeb J, Madill A . What Factors Might Drive Voluntary Childlessness (VC) in Women with IBD? Does IBD-specific Pregnancy-related Knowledge Matter?. J Crohns Colitis. 2016; 10(10):1151-8. DOI: 10.1093/ecco-jcc/jjw078. View

Kammerlander H, Nielsen J, Kjeldsen J, Knudsen T, Friedman S, Norgard B . The Effect of Disease Activity on Birth Outcomes in a Nationwide Cohort of Women with Moderate to Severe Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017; 23(6):1011-1018. DOI: 10.1097/MIB.0000000000001102. View

Sutton R, Wierstra K, Bal J, Ismond K, Dieleman L, Halloran B . Pregnancy-Related Beliefs and Concerns of Inflammatory Bowel Disease Patients Modified After Accessing e-Health Portal. J Can Assoc Gastroenterol. 2021; 4(1):27-35. PMC: 7898372. DOI: 10.1093/jcag/gwz036. View

McDermott E, Healy G, Mullen G, Keegan D, Byrne K, Guerandel A . Patient Education in Inflammatory Bowel Disease: A Patient-Centred, Mixed Methodology Study. J Crohns Colitis. 2018; 12(4):419-424. DOI: 10.1093/ecco-jcc/jjx175. View

Selinger C, Carey N, Cassere S, Nelson-Piercy C, Fraser A, Hall V . Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society. Frontline Gastroenterol. 2021; 12(3):182-187. PMC: 8040496. DOI: 10.1136/flgastro-2020-101459. View

Vermeire S, Carbonnel F, Coulie P, Geenen V, Hazes J, Masson P . Management of inflammatory bowel disease in pregnancy. J Crohns Colitis. 2012; 6(8):811-23. DOI: 10.1016/j.crohns.2012.04.009. View

Studd C, Cameron G, Beswick L, Knight R, Hair C, McNeil J . Never underestimate inflammatory bowel disease: High prevalence rates and confirmation of high incidence rates in Australia. J Gastroenterol Hepatol. 2015; 31(1):81-6. DOI: 10.1111/jgh.13050. View

Flanagan E, Richmond J, Thompson A, Desmond P, Bell S . Addressing pregnancy-related concerns in women with inflammatory bowel disease: Insights from the patient's perspective. JGH Open. 2021; 5(1):28-33. PMC: 7812482. DOI: 10.1002/jgh3.12442. View

10.

Thapwong P, Norton C, Rowland E, Farah N, Czuber-Dochan W . A systematic review of the impact of inflammatory bowel disease (IBD) on family members. J Clin Nurs. 2022; 32(9-10):2228-2238. DOI: 10.1111/jocn.16446. View

11.

Ghorayeb J, Branney P, Selinger C, Madill A . When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease. Qual Health Res. 2018; 28(8):1283-1294. DOI: 10.1177/1049732318763114. View

12.

Ellul P, Zammita S, Katsanos K, Cesarini M, Allocca M, Danese S . Perception of Reproductive Health in Women with Inflammatory Bowel Disease. J Crohns Colitis. 2016; 10(8):886-91. DOI: 10.1093/ecco-jcc/jjw011. View

13.

Purewal S, Chapman S, Czuber-Dochan W, Selinger C, Steed H, Brookes M . Systematic review: the consequences of psychosocial effects of inflammatory bowel disease on patients' reproductive health. Aliment Pharmacol Ther. 2018; 48(11-12):1202-1212. PMC: 6587548. DOI: 10.1111/apt.15019. View

14.

Chu J, Hardy P, Beeson L, Coomarasamy A . What is the best method for managing early miscarriage?. BMJ. 2020; 368:l6438. DOI: 10.1136/bmj.l6438. View

15.

Picciarelli Z, Stransky O, Leech M, Michel H, Schwartz M, Kim S . Exploring Reproductive Health Decision Experiences and Preferences of Women With Pediatric-Onset Inflammatory Bowel Diseases. Crohns Colitis 360. 2023; 4(1):otab083. PMC: 9802148. DOI: 10.1093/crocol/otab083. View

16.

Gawron L, Goldberger A, Gawron A, Hammond C, Keefer L . Disease-related pregnancy concerns and reproductive planning in women with inflammatory bowel diseases. J Fam Plann Reprod Health Care. 2015; 41(4):272-7. PMC: 8451967. DOI: 10.1136/jfprhc-2014-101000. View

17.

Karadag P, Morris B, Woolfall K . The information and support needs of patients living with inflammatory bowel disease: A qualitative study. Chronic Illn. 2020; 18(2):356-369. PMC: 9163778. DOI: 10.1177/1742395320968617. View

18.

Selinger C, Eaden J, Selby W, Brian Jones D, Katelaris P, Chapman G . Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis. 2012; 7(6):e206-13. DOI: 10.1016/j.crohns.2012.09.010. View

19.

Hashash J, Kane S . Pregnancy and Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2016; 11(2):96-102. PMC: 4836574. View

20.

Wlodarczyk M, Wlodarczyk J, Zalewska K, Olczyk M, Marynczak K, Gajewski P . Preferences of patients with inflammatory bowel disease for receiving specialized health services using technology: the role of Internet and other sources of medical information. Pol Przegl Chir. 2019; 91(2):1-6. DOI: 10.5604/01.3001.0012.8555. View