Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease

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.

Key Words::

• adherence
• Crohn’s disease
• disease activity
• medical treatment
• postpartum period
• reproduction

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.