Dr Aminda Nanayakkara2
1Sunshine Coast Hospital And Health Service, Birtinya, Australia, 2Griffith University School of Medicine and Dentistry, Birtinya, Australia
Biography:
Aminda Nanayakkara is a General Medicine and Obstetric Medicine Advanced Trainee at the Sunshine Coast University Hospital and is their current Medical Education Registrar.
Abstract:
Background: Inflammatory bowel disease (IBD) is an increasingly prevalent condition amongst the pregnant population (1) with historical heterogeneity in recommendations provided to women during their preconception and antenatal period (2,3). The Sunshine Coast Hospital and Health Service (SCHHS) consulted multi-disciplinary expertise and in February 2022 implemented a local “Pregnancy Care Pathway for Women with Inflammatory Bowel Disease” to standardise the evidence-based management of this cohort.
This audit evaluated the impact of this pathway by measuring adherence to current guidelines and patient outcomes before and after pathway implementation.
Methods: The care of all pregnant women with IBD and at least one recorded encounter under SCHHS Obstetric Medicine service was compared in the two years immediately before and after pathway implementation (2020-2021 and 2022-2023 respectively). 58 patients were identified (31 pre-pathway and 27 post-pathway).
Adherence to current recommendations for medication use, disease and pregnancy monitoring, nutrient screening, flare management and follow up was evaluated.
Data was also collected relating to IBD disease activity, pregnancy complications and neonatal outcomes.
Results: There was a statistically significant increase in adherence to current recommendations after pathway implementation (67% vs 13%, p<0.01). Appreciating that medication safety advice has changed over time, a separate analysis showed a significant difference in compliance to other aspects of care even without medications being accounted for (67% vs 39%, p=0.03).
There was a statistically significant reduction in hospitalisations for IBD (0% vs 18%, p=0.03), with non-statistically significant trends towards improved pregnancy outcomes.
Conclusion: Implementation of the pathway appeared to augment adherence to current evidence-based guidelines. Despite possible confounders in this small cohort, this improved adherence may have aided the reduction in IBD-related hospitalisations. A larger cohort may lend statistical significance to other trends of improved pregnancy outcomes observed in this audit.
Keywords
IBD, pregnancy, pathway
References
1. Grigorescu RR, Husar-Sburlan IA, Rosulescu G, Bobirca A, Cerban R, Bobirca F, et al. Pregnancy in Patients with Inflammatory Bowel Diseases-A Literature Review. Life (Basel). 2023 Feb 9;13(2):475.
2. Liu E, Laube R, Leong RW, Fraser A, Selinger C, Limdi JK. Managing Inflammatory Bowel Disease in Pregnancy: Health Care Professionals' Involvement, Knowledge, and Decision Making. Inflamm Bowel Dis. 2023 Apr 3;29(4):522-30.
3. Kashkooli SB, Andrews JM, Roberts MB, Selinger CP, Leong RW. Inflammatory bowel disease-specific pregnancy knowledge of gastroenterologists against general practitioners and obstetricians. United European Gastroenterol J. 2015 Oct;3(5):462-70.