Documentation of reproductive health counseling and contraception in women with inflammatory bowel diseases

Objective: Inflammatory bowel diseases (IBD) are commonly diagnosed during women's reproductive years. Counseling is important to avoid unintended pregnancy in a disease-poor state. We sought to determine reproductive counseling documentation by gastroenterologists in women with IBD. Methods: An electronic query identified women, age 18-45, with IBD in an academic gastroenterology practice from 2010 to 2012. A random sample (15%) chart review determined contraception documentation and content/frequency of reproductive counseling. Results: 100 patients were analyzed. Median age was 35 (range 19-45), 53% were married, and 69% had Crohn's disease. Median time since IBD diagnosis was 9 years (range 1-32) with a 5 visit median (range 1-45) over 31 months (range 1-105). A contraceptive method was identified in 24% of all patients. Nineteen patients (19%) had documentation of reproductive counseling. Only 1/100 patients had a specific reference to using contraception to avoid pregnancy. The remaining counseling included (1) medication effects on pregnancy, (2) disease control before pregnancy, or (3) mode of delivery planning. Conclusions: Outside of listing contraception as a "current medication", documentation of reproductive counseling at gastroenterology visits for IBD is sparse. Practice implications: In light of the importance of reproductive planning for women with IBD, future research on incentives and barriers to counseling is warranted.