Consultation: Christina Ha
Date: April 1, 2011
IBD. Pregnancy. Dealing with the mix.
Inflammatory bowel disease has the unfortunate habit of striking too many women in their prime childbearing years, raising special concerns about the consequences of using standard medications during pregnancy. IBD expert Tina Ha offers guidance.
What’s the most important thing for both physicians and female IBD patients in their childbearing years to know about?
I’m a believer in getting sustained remission of IBD before pregnancy and maintaining it through the entire nine months and post-delivery, as best as possible. Most studies support the safety of IBD treatments for women in their childbearing years, as well as the necessity: Uncontrolled IBD increases the risk of adverse outcomes for mother and baby.
What’s the biggest obstacle to young women getting screened and treated for IBD?
I think the brevity of modern medical checkups is the biggest culprit. Most visits with internists, gynecologists or even gastroenterologists are short follow-ups for a single concern. This makes it hard to address delicate areas of fertility, sexuality and pregnancy.
It’s important for doctors to develop good rapport with patients before addressing these issues. But then the obstacle is that we sometimes don’t think to ask. Even gastroenterologists don’t always think to look beyond the colon and small bowel.
Is there a special challenge in getting female IBD patients to talk about the condition?
Yes. There are a lot of psychological issues that women might bring to the subject, often relating to body image and emotional well-being. IBD can manifest with distressing symptoms like perianal discharge, bleeding, incontinence—all of which can impact intimacy with a partner. The disease really affects a woman’s life significantly.
Is there a proven best approach for physicians to help their female patients in addressing the topic?
It can be hard to bring up on the first visit, but it’s certainly important to take time to learn a patient’s full medical history. Ask if a patient has any family history of Crohn’s disease or ulcerative colitis. If the physician can identify symptoms of the conditions, then it’s good to ask the broader questions: How are you coping? How is this affecting your life? How is work going?
What are the most recommended treatments for women with IBD who’re thinking of having children?
It’s important to know we currently have no cure for IBD. But patients with it are typically as fertile as those without. Fortunately, modern therapies can be very effective at reducing symptoms if used properly and steadily. The key thing is that any woman with IBD who wants to become pregnant should try to become symptom-free for an extended period prior to conception.
Our current arsenal of treatments is mostly safe throughout pregnancy, but there’s no substitute for multidisciplinary planning—close communication between a patient, her gastroenterologist and obstetrician.
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