Abstract
Objectives. 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.
Acknowledgements
The authors gratefully acknowledge the physicians at the hospitals involved.
Declaration of interest: Dr. Mette Julsgaard has served as a speaker for AbbVie A/S and MSD A/S. Dr. Christian Lodberg Hvas has served as a speaker for AbbVie A/S and MSD A/S. Dr. Lisbet Ambrosius Christensen has served as a speaker for Ferring A/S, MSD A/S, and AbbVie A/S and is a member of the advisory board for MSD A/S. The remaining authors declare no conflicts of interest. This study was funded in part by the Danish Colitis-Crohn association (grant number 8889) and the A.P. Moeller Foundation of the Advancement of Medical Science. The Danish Ministry of Health has financially supported Dr. Mette Julsgaard (identification number 271-05-0775). The funding has in no way affected the study design, data collection, analysis, interpretation of the data or the writing of the report.