N16 Optimizing care for women of childbearing age with Inflammatory Bowel Disease: Developing a specific pathway utilizing European Crohn's and Colitis Organisation guidelines and the American Gastroenterology Association recommendations
Authors: De Dycker E , Geens P , Lambrechts T , Loddewijkx E , Paps A , Degry J , D’Hondt C , Matthijs A , Vermeire S , Sabino J , Verstockt B , Lannoo L , Van Calsteren K , Ferrante M 
Published: January 2025

Abstract

Background
Recent advances have greatly improved our understanding of the interaction between Inflammatory bowel disease (IBD) and reproductive health. The European Crohn's and Colitis Organisation (ECCO) and the American Gastroenterology Association (AGA) have both provided valuable guidelines to support best practices in this area.1,2 Translating these guidelines into a practical care pathway is useful for patients with a pregnancy wish or for those who are already pregnant, ensuring effective implementation in daily practice.

Methods
Our goal was to develop the IBD multIdiscipliNary Family plAnning uz leuveN care paThWay (IBD INFANT Wish) and to improve preconception counselling for IBD patients with a pregnancy wish. To develop, implement and evaluate this pathway, we applied a 7-phase model.3 Our structured approach aims to provide comprehensive, multidisciplinary care tailored to the unique challenges and needs of IBD patients during preconception, pregnancy and postpartum.

Results
After completing the first three phases of the 7-phase methodology, we went on to develop the IBD INFANT Wish. The development of this care pathway took into account different trajectories depending on patient type, expected risks and comorbidities. This approach ensures that each patient's unique circumstances are addressed, providing tailored and effective care throughout the pathway.
The care pathway (see Figure) is structured as a time-task matrix, mapping the journey of a female IBD patient from (active) pregnancy wish through the postpartum period, outlining the necessary actions at each stage (preconception, pregnancy and postpartum).
Besides the care pathway, other tools were developed. An information display was created for the infusion ward and outpatient clinic to highlight the importance of preconception counselling. A preconception counselling template was developed to ensure that general practitioners and peripheral obstetricians are aware of counselling their IBD patients. In addition, an information brochure has been created providing comprehensive information on preconception and supporting patients in a healthy pregnancy. A decision tree was developed to help the IBD team provide optimal care for patients who want to become pregnant or are pregnant already, with a focus on high-risk pregnancies. Finally, a sticker about vaccinations for the baby was made for the baby's vaccination booklet in case the mother received biological therapy during pregnancy.

Conclusion
The development of the IBD INFANT Wish marks a significant advancement in guiding IBD patients of childbearing age, providing multidisciplinary and evidence-based care tailored to improve both maternal and infant outcomes while setting a new standard for future practice.

References
1.Torres J, Chaparro M, Julsgaard M, et al. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis. 2023;17(1):1-27. doi:10.1093/ecco-jcc/jjac115
2.Mahadevan U, Robinson C, Bernasko N, et al. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. 2019;156(5):1508-1524. doi:10.1053/j.gastro.2018.12.022
3.Vanhaecht K, Van Gerven E, Deneckere S, et al. 7 fasenmodel voor de ontwikkeling, implementatie, evaluatie en continue opvolging van zorgpaden. Tijdschrift voor geneeskunde. 2011; 67 (10), 473-481. doi:10.2143/TVG.67.10.2000969