title: Perception of Reproductive Health in Women with Inflammatory Bowel Disease.
abstract: OBJECTIVE
  As inflammatory bowel diseases [IBD] affect female patients almost exclusively during their reproductive age, issues related to fertility, fecundity, pregnancy, delivery, and lactation are of utmost importance. Lack of education and misconceptions regarding the effect of disease and/or treatment on reproductive outcome may lead to voluntary childlessness and/or development of unwanted cervical pathologies which may impact tremendously on patients' welfare and quality of life. The aims of this study were to assess the perspectives of IBD patients on fertility, pregnancy and its outcomes, and lactation, as well as their awareness of human papillomavirus [HPV]-related pathologies and screening for cervical cancer.
  
  
  METHODS
  This prospective study was performed across nine different Mediterranean IBD centres between 2014 and 2015 and included consecutive female IBD patients between the ages of 16 and 50 years. All patients responded to a questionnaire based on ECCO guidelines.
  
  
  RESULTS
  A total of 348 IBD female patients with a mean age of 37.4 (standard deviation [SD] ± 2.1) years were recruited; 50% had a diagnosis of ulcerative colitis, 49.4% had Crohn`s disease, and 0.6% patients had a diagnosis of indeterminate colitis [IC]. A significant proportion of patients [ > 60%] were afraid that IBD may lead to a complicated pregnancy and that the disease itself and/or its medications can cause fetal harm. Patients had similar concerns that IBD can be transmitted to their offspring as well as with regard to breastfeeding. Counselling from health care professionals with regard to fertility, pregnancy, and lactation was associated positively with the highest number of pregnancies and inversely with the lowest number of patients who considered voluntary childlessness [p < 0.0001]. Patients with a higher level of education were more likely to get pregnant [p = 0.004]. There was a low uptake of the HPV vaccine. However, there was a reasonably good uptake of cervical cancer screening.
  
  
  CONCLUSIONS
  Our study demonstrates that women with IBD have misperceptions about fertility, pregnancy, and health maintenance. We also show that education by physicians has a positive influence. We thus conclude that improved multidisciplinary approaches should be used to educate and implement European guidelines for women with IBD.
authors.affiliation: Division of Gastroenterology, Mater Dei Hospital, Malta ellul.pierre@gmail.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ellul
authors.affiliation: Division of Gastroenterology, Mater Dei Hospital, Malta.
authors.forename: Stephania Chectuti
authors.initials: SC
authors.lastname: Zammita
authors.affiliation: Department of Internal Medicine, University of Ioannina School of Medical Sciences, Ioannina, Greece.
authors.forename: Konstantinos H
authors.initials: KH
authors.lastname: Katsanos
authors.affiliation: Dipartimento di Medicina Interna e Specialita' Mediche, University of Rome 'Sapienza', Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Cesarini
authors.affiliation: IBD Center, IRCCS Humanitas, Milan, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Allocca
authors.affiliation: IBD Center, IRCCS Humanitas, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.affiliation: Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Karatzas
authors.affiliation: Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Sara Canora
authors.initials: SC
authors.lastname: Moreno
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.affiliation: IBD Center, IRCCS Humanitas, Milan, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.affiliation: Hospital Beatriz Ângelo, Gastroenterology Department, Loures, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Torres
authors.affiliation: Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Sanroman
authors.affiliation: Division of Gastroenterology, Mater Dei Hospital, Malta.
authors.forename: Mandy
authors.initials: M
authors.lastname: Caruana
authors.affiliation: Division of Gastroenterology, Mater Dei Hospital, Malta.
authors.forename: Louise
authors.initials: L
authors.lastname: Zammit
authors.affiliation: Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Mantzaris
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D005260:Female; D005298:Fertility; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000523:psychology*; D008875:Middle Aged; D010465:Perception; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D043762:Reproductive Behavior; D060728:Reproductive Health; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D055815:Young Adult
keywords: Inflammatory bowel disease; cervical screening; fertility; medications; pregnancy