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Homer-Perry R, Czuber-Dochan W, Wade T, Purewal S, Chapman SCE, Brookes M, Selinger CP, Steed H. Full title: "Hopes, worries and expectations" experiences of pregnancy with inflammatory bowel disease: An interpretative phenomenological analysis study. Heliyon 2024; 10:e31954. [PMID: 38868041 PMCID: PMC11167349 DOI: 10.1016/j.heliyon.2024.e31954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
Background and Aims Inflammatory Bowel Disease (IBD) affects many women of childbearing age. High levels of voluntary childlessness and high levels of pregnancy-related fears have been reported amongst these patients in several quantitative studies. We investigated the lived experiences of pregnant patients to better understand decision-making processes around family planning. Methods Nine participants between 7 and 34 weeks pregnant (6 Crohn's Disease/3 Ulcerative Colitis), with an age range of 22-39 were recruited prospectively from three United Kingdom hospitals. Semi-structured interviews were conducted, and audio recorded. Interpretative phenomenological analysis was used to interpret the data. Results Two main themes emerged: 1) IBD is perceived as a threat to family planning; and 2) healthcare professional advice, support, and reassurance was important. IBD was viewed as a potential threat to fertility and reproductive health. Consequently, women's lived experience of pregnancy is shaped by anxiety and pregnancy-related worries for mother and baby. Mothers actively sought out expert medical assurances to alleviate some of the perceived fears. Conclusion Previous research has repeatedly found that women with IBD exhibit high levels of pregnancy-related worries and anxieties. Our findings find that high levels of anxiety are due to patients' perceptions that IBD is a threat to their reproductive health and their offspring. Women relied on a medicalized discourse to understand their IBD experiences during pregnancy and actively sought biomedical resources for assistance before and during pregnancy. Consultants should be aware that when dealing with pregnant patients, some women may experience anxiety and require extra support.
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Affiliation(s)
- Rebecca Homer-Perry
- University of Wolverhampton, Faculty of Education, Health, and Wellbeing, Psychology Department, Wulfruna Street, Wolverhampton, WV1 1LY, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom
| | - Satvinder Purewal
- University of Wolverhampton, Faculty of Education, Health, and Wellbeing, Psychology Department, Wulfruna Street, Wolverhampton, WV1 1LY, United Kingdom
| | - Sarah CE. Chapman
- Department of Pharmacy & Pharmacology, Faculty of Science, University of Bath, United Kingdom & Institute of Pharmaceutical Science, King's College London, United Kingdom
| | - Matthew Brookes
- University of Wolverhampton, Faculty of Education, Health, and Wellbeing, Psychology Department, Wulfruna Street, Wolverhampton, WV1 1LY, United Kingdom
- Gastroenterology Unit, New Cross Hospital, Wednesfield Road, The Royal Wolverhampton NHS Trust, United Kingdom
| | - Christian P. Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, United Kingdom
| | - Helen Steed
- University of Wolverhampton, Faculty of Education, Health, and Wellbeing, Psychology Department, Wulfruna Street, Wolverhampton, WV1 1LY, United Kingdom
- Gastroenterology Unit, New Cross Hospital, Wednesfield Road, The Royal Wolverhampton NHS Trust, United Kingdom
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Selinger CP, Steed H, Purewal S, Homer R, Brookes M. Factors Associated with Family Planning Status and Voluntary Childlessness in Women of Childbearing Age with Inflammatory Bowel Diseases. J Clin Med 2023; 12:4267. [PMID: 37445302 DOI: 10.3390/jcm12134267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Women with Inflammatory Bowel Diseases (IBD) have fewer children and stay childless more often. The decision-making process around family planning choices remains incompletely understood. METHODS We examined family status in women who at recruitment to the UK IBD Bioresource had not had children yet via an electronic survey. The primary outcome was the proportion of women with voluntary childlessness. Secondary outcomes were factors associated with family planning status. RESULTS Of 326 responders, 10.7% had either given birth, were currently pregnant or were currently trying to conceive; 12.6% were planning to conceive within 12 months; 54.4% were contemplating conception in the distant future (vague plans); and 22.3% were voluntarily childless. Factors associated with family planning status fell into three areas: general background (age, household income, perceived support to raise a child), relationship status (sexual orientation, being single, not cohabiting, perception of being 'in the right relationship to raise a child', perception of a good sex life) and the expression of having a child as a goal in life. On binary logistics regression analysis with voluntary childlessness versus vague family plans as the outcomes of choice, having a household income of <£30,000 (p = 0.046), not seeing a child as a life goal (p < 0.0001) and identifying as lesbian or bisexual (p = 0.047) were independent predictors of voluntary childlessness. CONCLUSIONS Clinicians should consider sexual orientation, income, younger age, current relationship and lack of expression of having a child as a life goal as important factors for family planning when providing care. Pre-pregnancy advice should be made widely available for women with IBD.
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Affiliation(s)
- Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals, Leeds LS9 7TF, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS9 7TF, UK
| | - Helen Steed
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Satvinder Purewal
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Rebecca Homer
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
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Rabinowitz LG, Rabinowitz DG, Silver EM, Oxentenko AS, Williams KE, Silver JK. Disparities Persist in Inclusion of Female, Pregnant, Lactating, and Older Individuals in Inflammatory Bowel Disease Clinical Trials. Gastroenterology 2022; 163:8-13. [PMID: 35288114 DOI: 10.1053/j.gastro.2022.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Loren G Rabinowitz
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Danielle G Rabinowitz
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily M Silver
- Department of Psychology, University of Chicago, Chicago, Illinois
| | - Amy S Oxentenko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kevin E Williams
- Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Kuipers YJ, Bleijenbergh R, Van den Branden L, van Gils Y, Rimaux S, Brosens C, Claerbout A, Mestdagh E. Psychological health of pregnant and postpartum women before and during the COVID-19 Pandemic. PLoS One 2022; 17:e0267042. [PMID: 35421171 PMCID: PMC9009654 DOI: 10.1371/journal.pone.0267042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background The COVID-19 pandemic is likely to influence psychological health of pregnant and postpartum women. Methods We conducted a non-concurrent cross-sectional study among 1145 women living in the Dutch-speaking part of Belgium, 541 pregnant and 604 postpartum women. We measured psychological health with the Whooley questions, Generalized Anxiety Disorder 2-item (GAD-2) and the Edinburgh Postnatal Depression Scale (EPDS) and compared the scores of pregnant and postpartum women before and during the COVID-19 pandemic. Results No differences were observed in the Whooley, GAD-2 or EPDS scores among pregnant women. The postpartum total GAD-2 scores before vs during the pandemic showed significant differences. Controlling for confounders, we observed a small main positive effect of having an infant during time of COVID-19 (F(1.13) = 5.06, p.025, d.27). The effect was significantly larger for women with (a history of) perinatal psychological problems (F(1.12) = 51.44, p < .001, d.82). Emotional support was significantly related to GAD-2 scores of postpartum women during the pandemic (F(1.90) = 35.54, p < .001). Postpartum women reported significant higher effects of the pandemic on their behavior compared to pregnant women (p.034). Conclusion The COVID-19 pandemic seems to have a positive effect on postpartum women during the first year postpartum, in particular for women with (a history of) perinatal psychological problems and for those women who experienced emotional support. The findings suggest that less external stimuli caused by lockdown restrictions might have a positive effect on postpartum women’s emotional wellbeing. The sample consisted of white, educated women in a relationship and information regarding the extent of exposure to adverse COVID-19 consequences was lacking. We relied on self-selection and self-report. The postpartum pandemic sample was small.
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Affiliation(s)
- Yvonne J. Kuipers
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
- * E-mail:
| | - Roxanne Bleijenbergh
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Laura Van den Branden
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Yannic van Gils
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Sophie Rimaux
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
| | - Charlotte Brosens
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
| | - Astrid Claerbout
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
| | - Eveline Mestdagh
- Department of Health and Social Care, School of Midwifery, AP University College, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
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Riazuelo H. Becoming a mother when suffering from a chronic illness. Front Psychiatry 2022; 13:1059648. [PMID: 36756636 PMCID: PMC9900098 DOI: 10.3389/fpsyt.2022.1059648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/31/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The critical period of early motherhood when facing serious health problems constitutes a major public health issue. The disease may interfere with, influence, and compound the difficulties experienced over the course of pregnancy and during the parenthood processes. These processes are to be understood as a passage involving so many changes and fraught with difficulties leading to a series of psychological mobilizations. Illness also needs to be considered as a moment of transition, sometimes of severance, marking the lives of the people concerned in a more or less lasting way. Various developments are possible, some of which can be envisaged as leading to more positive outcomes, while others appear as if blocked or doomed to failure. CLINICAL DATA AND METHOD This clinical study is the result of twelve analytically oriented psychotherapeutic follow-ups. The sessions took place weekly over periods ranging from 1 to 6 years. Some of the patients we met had become pregnant while they had a declared but not yet chronic nephropathy. The other patients were already on dialysis and had become mother before starting dialysis. There is also one instance of a pregnant patient on dialysis. In the background, there are also many women who talked about giving up fertility and motherhood. After an in-depth study of each follow-up, a cross-sectional study was conducted to identify the main themes. RESULTS AND DISCUSSION Main considerations on the psychotherapeutic treatment: We regularly observe people who find it impossible to muster the internal resources that would enable them to deal with the trials they undergo in such situations. For the psychologist, there is a need to listen to archaic remnants. Gradually, in the space of psychotherapeutic work, possibilities of "reanimation" of the psyche emerge, an internal space that renews fantasmatic activity as it begins to be able to project into the external space and into the space of the sessions.
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Affiliation(s)
- Hélène Riazuelo
- UFR Sciences Psychologiques et Sciences de l'Éducation (UFR SPSE), Université Paris Nanterre, Nanterre, France.,Nephrology Psychosomatic Unit, Aura Paris Plaisance (APP), Paris, France
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Gelech J, Desjardins M, Mazurik K, Duerksen K, McGuigan-Scott K, Lichtenwald K. Understanding Gut Feelings: Transformations in Coping With Inflammatory Bowel Disease Among Young Adults. QUALITATIVE HEALTH RESEARCH 2021; 31:1918-1936. [PMID: 33980095 PMCID: PMC8446882 DOI: 10.1177/10497323211011442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Past studies have revealed a dizzying array of coping techniques employed by persons living with inflammatory bowel disease (IBD). Unfortunately, research has provided little insight into when and why individuals adopt or abandon particular coping strategies. Using a retrospective narrative approach, we explored how participants made sense of changes in their approach to coping over time. Shifts in coping strategies were associated with particular illness experiences that wrought new understandings of IBD and novel identity challenges. They followed a common processual form and were marked by a movement away from techniques of purification, normalization, and banalization toward the development of a more communicative body. This was accompanied by notable shifts in identity work. Notably, participants moved from a preoccupation with maintaining continuity and sameness to permitting their extraordinary bodies to occupy a place in their public and personal identities. Implications of this process for theory and practice are discussed.
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Affiliation(s)
- Jan Gelech
- University of Saskatchewan,
Saskatoon, Saskatchewan, Canada
| | | | | | - Kari Duerksen
- University of Victoria, Victoria,
British Columbia, Canada
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Volpato E, Bosio C, Previtali E, Leone S, Armuzzi A, Pagnini F, Graffigna G. The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review. BMC Gastroenterol 2021; 21:293. [PMID: 34261434 PMCID: PMC8278693 DOI: 10.1186/s12876-021-01850-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal. Aims In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle. Methods Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo. Results We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle. Conclusions The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01850-1.
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Affiliation(s)
- E Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy. .,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - C Bosio
- EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
| | - E Previtali
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - A Armuzzi
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,IRCCS Policlinico Gemelli, Rome, Italy
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
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