title: Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn's disease.
abstract: OBJECTIVE
  Adherence to medical treatment among women with Crohn's disease (CD) in the postpartum period has never been examined. The impact of breast-feeding on disease activity remains controversial. We aimed to assess rates of non-adherence to medical treatment among women with CD in the postpartum period. Further, to assess breast-feeding rates and the impact of breast-feeding on the risk of relapse.
  
  
  METHODS
  Within a population of 1.6 million, we identified 154 women with CD who had given birth within a 6-year period. We combined questionnaire data, data from medical records and public register data. We used logistic regression to estimate prevalence odds ratios (POR) for non-adherence, relapse and breast-feeding according to different predictors.
  
  
  RESULTS
  Among 105 (80%) respondents, 59 (56%) reported taking medication. Of these, 66.1% reported to be adherent to medical treatment. Fear of medication transmission to the breast milk was stated as the reason for non-adherence in 60%. Those who received counselling regarding medical treatment were less likely to be non-adherent (POR 0.55, 95% confidence interval [CI] 0.1-2.5). In total, 87.6% were breast-feeding. Breast-feeding rates did not vary by medical treatment. Predictors for relapse in CD were smoking (POR 1.85, 95% CI 0.62-5.54) and non-adherence among medical treated (POR 1.25, 95% CI 0.26-6.00). Breast-feeding seemed protective against relapse (POR 0.33, 95% CI 0.10-1.26).
  
  
  CONCLUSIONS
  Adherence to medical treatment in the postpartum period was high, and counselling seemed to increase adherence. Relapse may be explained by non-adherence or smoking while breast-feeding seemed protective.
authors.affiliation: Department of Hepatology and Gastroenterology V, Aarhus University Hospital , 8000 Aarhus C , Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Julsgaard
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
authors.forename: Christian Lodberg
authors.initials: CL
authors.lastname: Hvas
authors.forename: Anne
authors.initials: A
authors.lastname: Grosen
authors.forename: Sara
authors.initials: S
authors.lastname: Hasseriis
authors.forename: Lisbet Ambrosius
authors.initials: LA
authors.lastname: Christensen
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
keywords: Crohn’s disease; adherence; disease activity; medical treatment; postpartum period; reproduction