Preventive Health Care Among Postpartum Women With Inflammatory Bowel Disease: Results From the PIANO Registry

Eric J Mao; Sarah Sheibani; Christopher Martin; Richard S Bloomfeld; Kim Isaacs; Sumona Saha; Uma Mahadevan

doi:10.1093/ibd/izy293

Preventive Health Care Among Postpartum Women With Inflammatory Bowel Disease: Results From the PIANO Registry

Inflamm Bowel Dis. 2019 Mar 14;25(4):797-802. doi: 10.1093/ibd/izy293.

Authors

Eric J Mao¹, Sarah Sheibani², Christopher Martin³, Richard S Bloomfeld⁴, Kim Isaacs³, Sumona Saha⁵, Uma Mahadevan¹

Affiliations

¹ Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California.
² Department of Medicine, Division of Gastroenterology, University of Southern California, Los Angeles, California.
³ Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina.
⁴ Department of Medicine, Section of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
⁵ Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

PMID: 30256951
DOI: 10.1093/ibd/izy293

Abstract

Background: Health care maintenance (HCM) is reduced among inflammatory bowel disease (IBD) patients. This study aims to characterize rates of HCM in a closely monitored subpopulation-postpartum women with IBD-and identify predictors of noncompliance.

Methods: A national prospective pregnancy registry was utilized to collect completion rates of HCM recommendations (cervical cancer screening; osteoporosis screening; pneumococcal, hepatitis A, hepatitis B, and influenza vaccines). Completion of a recommendation at least once during follow-up was sufficient, except for influenza vaccine, which was assessed yearly. Patients were classified by drug exposures: immunomodulator (Group A), biologic (Group B), combination therapy (Group AB), and unexposed. Confounders assessed were steroid exposure, IBD flare, IBD care site, primary care provider (PCP) access, marital status, income, education level, and race.

Results: There were 628 postpartum IBD women with at least 1 year of follow-up. HCM rates were as follows: cervical cancer screening (84%), osteoporosis screening (54%), pneumococcal (50%), hepatitis A (61%), hepatitis B (81%), and influenza (72%) vaccines. The unexposed group demonstrated lower pneumococcal vaccination rates than groups A, B, and AB. Group B demonstrated lower cervical cancer screening rates than the unexposed. PCP access and low education predicted hepatitis vaccine noncompliance. Unmarried status and low income predicted cervical cancer screening noncompliance. Low income predicted influenza vaccine noncompliance.

Conclusions: Postpartum women have multiple providers, yet they complete HCM at suboptimal rates. Risk factors include biologic exposure, unmarried status, low income, low education, and access to a PCP. Awareness among providers and patients is important and needs to be enhanced.

Keywords: cervical cancer screening; health care maintenance; immunizations; inflammatory bowel disease; osteoporosis screening; postpartum.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Follow-Up Studies
Humans
Infections / drug therapy*
Inflammatory Bowel Diseases / drug therapy*
Patient Compliance / statistics & numerical data
Postpartum Period / psychology*
Practice Guidelines as Topic / standards
Preventive Health Services / standards*
Prognosis
Prospective Studies
Registries / statistics & numerical data*
Uterine Cervical Neoplasms / prevention & control*
Vaccination / statistics & numerical data*