Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes
Background Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter...
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| Veröffentlicht in: | Digestive diseases and sciences 2021-02, Vol.66 (2), p.577-586 |
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| creator | Watanabe, Chikako Nagahori, Masakazu Fujii, Toshimitsu Yokoyama, Kaoru Yoshimura, Naoki Kobayashi, Taku Yamagami, Hirokazu Kitamura, Kazuya Takashi, Kagaya Nakamura, Shiro Naganuma, Makoto Ishihara, Shunji Esaki, Motohiro Yonezawa, Maria Kunisaki, Reiko Sakuraba, Atsushi Kuji, Naoaki Miura, Soichiro Hibi, Toshifumi Suzuki, Yasuo Hokari, Ryota |
| description | Background
Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference.
Methods
Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes.
Results
Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians’ estimate (
p
= 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928–30.427,
p
= 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350–51.994,
p
= 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse (
p
= 0.002).
Conclusion
Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted. |
| doi_str_mv | 10.1007/s10620-020-06221-6 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2386444216</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A712933703</galeid><sourcerecordid>A712933703</sourcerecordid><originalsourceid>FETCH-LOGICAL-c508t-7745cfa67410fc6105064f13ac435865d07d7ccc1231608c82dcb52d5baf85273</originalsourceid><addsrcrecordid>eNp9UU1vEzEUtBCIhsAf4IAscelli7-9OUaBAlKhPdCz5dhvg6uNXWxvpR77z_EqgQqEkPVkezwzen6D0GtKzigh-l2hRDHSkbkUY7RTT9CCSs07JlX_FC0IVe1MqTpBL0q5IYSsNFXP0QlnTKy45gv08DXFzvrvkCE6wDXhL-CDszWkWHCI-CrDLtpY8fXoIDf8DvAmjaGGgq_aFWItDYg1h-1UocwW70MBWwCfjzY3xEaP1_4OcoOOdu4eX07VpT2Ul-jZYMcCr477El2ff_i2-dRdXH78vFlfdE6SvnZaC-kGq7SgZHCKEkmUGCi3TnDZK-mJ9to5RxmnivSuZ95tJfNya4deMs2X6PTge5vTjwlKNftQHIyjjZCmYhjvlRCCtZkt0du_qDdpyrF1Z5jolWojFeKRtbMjmBCHVLN1s6lZa8pWnGvCG-vsH6y2POyDSxGG0PA_BOwgcDmVkmEwtznsbb43lJg5d3PI3ZC55tzN3PGbY8fTdg_-t-RX0I3AD4TSnuIO8uOX_mP7E8gNtq8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2486621144</pqid></control><display><type>article</type><title>Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Watanabe, Chikako ; Nagahori, Masakazu ; Fujii, Toshimitsu ; Yokoyama, Kaoru ; Yoshimura, Naoki ; Kobayashi, Taku ; Yamagami, Hirokazu ; Kitamura, Kazuya ; Takashi, Kagaya ; Nakamura, Shiro ; Naganuma, Makoto ; Ishihara, Shunji ; Esaki, Motohiro ; Yonezawa, Maria ; Kunisaki, Reiko ; Sakuraba, Atsushi ; Kuji, Naoaki ; Miura, Soichiro ; Hibi, Toshifumi ; Suzuki, Yasuo ; Hokari, Ryota</creator><creatorcontrib>Watanabe, Chikako ; Nagahori, Masakazu ; Fujii, Toshimitsu ; Yokoyama, Kaoru ; Yoshimura, Naoki ; Kobayashi, Taku ; Yamagami, Hirokazu ; Kitamura, Kazuya ; Takashi, Kagaya ; Nakamura, Shiro ; Naganuma, Makoto ; Ishihara, Shunji ; Esaki, Motohiro ; Yonezawa, Maria ; Kunisaki, Reiko ; Sakuraba, Atsushi ; Kuji, Naoaki ; Miura, Soichiro ; Hibi, Toshifumi ; Suzuki, Yasuo ; Hokari, Ryota</creatorcontrib><description>Background
Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference.
Methods
Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes.
Results
Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians’ estimate (
p
= 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928–30.427,
p
= 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350–51.994,
p
= 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse (
p
= 0.002).
Conclusion
Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-020-06221-6</identifier><identifier>PMID: 32249373</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abortion, Spontaneous - diagnosis ; Abortion, Spontaneous - epidemiology ; Adult ; Age ; Analysis ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Biochemistry ; Colitis, Ulcerative - diagnosis ; Colitis, Ulcerative - drug therapy ; Colitis, Ulcerative - epidemiology ; Complications and side effects ; Drug dosages ; Drugs ; Female ; Gastroenterology ; Hepatology ; Humans ; Infant, Newborn ; Inflammatory bowel disease ; Medical colleges ; Medical research ; Medical treatment ; Medication Adherence ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Mesalamine - therapeutic use ; Oncology ; Original Article ; Patient compliance ; Patient outcomes ; Physicians ; Pregnancy ; Pregnancy Complications - diagnosis ; Pregnancy Complications - drug therapy ; Pregnancy Complications - epidemiology ; Pregnancy Outcome - epidemiology ; Pregnant women ; Premature Birth - diagnosis ; Premature Birth - epidemiology ; Prospective Studies ; Questionnaires ; Regression analysis ; Risk factors ; Surveys ; Symptom Flare Up ; Transplant Surgery ; Tumor necrosis factor-TNF ; Ulcerative colitis ; Womens health</subject><ispartof>Digestive diseases and sciences, 2021-02, Vol.66 (2), p.577-586</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>COPYRIGHT 2021 Springer</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-7745cfa67410fc6105064f13ac435865d07d7ccc1231608c82dcb52d5baf85273</citedby><cites>FETCH-LOGICAL-c508t-7745cfa67410fc6105064f13ac435865d07d7ccc1231608c82dcb52d5baf85273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-020-06221-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-020-06221-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32249373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Watanabe, Chikako</creatorcontrib><creatorcontrib>Nagahori, Masakazu</creatorcontrib><creatorcontrib>Fujii, Toshimitsu</creatorcontrib><creatorcontrib>Yokoyama, Kaoru</creatorcontrib><creatorcontrib>Yoshimura, Naoki</creatorcontrib><creatorcontrib>Kobayashi, Taku</creatorcontrib><creatorcontrib>Yamagami, Hirokazu</creatorcontrib><creatorcontrib>Kitamura, Kazuya</creatorcontrib><creatorcontrib>Takashi, Kagaya</creatorcontrib><creatorcontrib>Nakamura, Shiro</creatorcontrib><creatorcontrib>Naganuma, Makoto</creatorcontrib><creatorcontrib>Ishihara, Shunji</creatorcontrib><creatorcontrib>Esaki, Motohiro</creatorcontrib><creatorcontrib>Yonezawa, Maria</creatorcontrib><creatorcontrib>Kunisaki, Reiko</creatorcontrib><creatorcontrib>Sakuraba, Atsushi</creatorcontrib><creatorcontrib>Kuji, Naoaki</creatorcontrib><creatorcontrib>Miura, Soichiro</creatorcontrib><creatorcontrib>Hibi, Toshifumi</creatorcontrib><creatorcontrib>Suzuki, Yasuo</creatorcontrib><creatorcontrib>Hokari, Ryota</creatorcontrib><title>Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference.
Methods
Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes.
Results
Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians’ estimate (
p
= 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928–30.427,
p
= 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350–51.994,
p
= 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse (
p
= 0.002).
Conclusion
Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted.</description><subject>Abortion, Spontaneous - diagnosis</subject><subject>Abortion, Spontaneous - epidemiology</subject><subject>Adult</subject><subject>Age</subject><subject>Analysis</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Biochemistry</subject><subject>Colitis, Ulcerative - diagnosis</subject><subject>Colitis, Ulcerative - drug therapy</subject><subject>Colitis, Ulcerative - epidemiology</subject><subject>Complications and side effects</subject><subject>Drug dosages</subject><subject>Drugs</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Inflammatory bowel disease</subject><subject>Medical colleges</subject><subject>Medical research</subject><subject>Medical treatment</subject><subject>Medication Adherence</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Mesalamine - therapeutic use</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patient compliance</subject><subject>Patient outcomes</subject><subject>Physicians</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnosis</subject><subject>Pregnancy Complications - drug therapy</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>Pregnant women</subject><subject>Premature Birth - diagnosis</subject><subject>Premature Birth - epidemiology</subject><subject>Prospective Studies</subject><subject>Questionnaires</subject><subject>Regression analysis</subject><subject>Risk factors</subject><subject>Surveys</subject><subject>Symptom Flare Up</subject><subject>Transplant Surgery</subject><subject>Tumor necrosis factor-TNF</subject><subject>Ulcerative colitis</subject><subject>Womens health</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UU1vEzEUtBCIhsAf4IAscelli7-9OUaBAlKhPdCz5dhvg6uNXWxvpR77z_EqgQqEkPVkezwzen6D0GtKzigh-l2hRDHSkbkUY7RTT9CCSs07JlX_FC0IVe1MqTpBL0q5IYSsNFXP0QlnTKy45gv08DXFzvrvkCE6wDXhL-CDszWkWHCI-CrDLtpY8fXoIDf8DvAmjaGGgq_aFWItDYg1h-1UocwW70MBWwCfjzY3xEaP1_4OcoOOdu4eX07VpT2Ul-jZYMcCr477El2ff_i2-dRdXH78vFlfdE6SvnZaC-kGq7SgZHCKEkmUGCi3TnDZK-mJ9to5RxmnivSuZ95tJfNya4deMs2X6PTge5vTjwlKNftQHIyjjZCmYhjvlRCCtZkt0du_qDdpyrF1Z5jolWojFeKRtbMjmBCHVLN1s6lZa8pWnGvCG-vsH6y2POyDSxGG0PA_BOwgcDmVkmEwtznsbb43lJg5d3PI3ZC55tzN3PGbY8fTdg_-t-RX0I3AD4TSnuIO8uOX_mP7E8gNtq8</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Watanabe, Chikako</creator><creator>Nagahori, Masakazu</creator><creator>Fujii, Toshimitsu</creator><creator>Yokoyama, Kaoru</creator><creator>Yoshimura, Naoki</creator><creator>Kobayashi, Taku</creator><creator>Yamagami, Hirokazu</creator><creator>Kitamura, Kazuya</creator><creator>Takashi, Kagaya</creator><creator>Nakamura, Shiro</creator><creator>Naganuma, Makoto</creator><creator>Ishihara, Shunji</creator><creator>Esaki, Motohiro</creator><creator>Yonezawa, Maria</creator><creator>Kunisaki, Reiko</creator><creator>Sakuraba, Atsushi</creator><creator>Kuji, Naoaki</creator><creator>Miura, Soichiro</creator><creator>Hibi, Toshifumi</creator><creator>Suzuki, Yasuo</creator><creator>Hokari, Ryota</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210201</creationdate><title>Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes</title><author>Watanabe, Chikako ; Nagahori, Masakazu ; Fujii, Toshimitsu ; Yokoyama, Kaoru ; Yoshimura, Naoki ; Kobayashi, Taku ; Yamagami, Hirokazu ; Kitamura, Kazuya ; Takashi, Kagaya ; Nakamura, Shiro ; Naganuma, Makoto ; Ishihara, Shunji ; Esaki, Motohiro ; Yonezawa, Maria ; Kunisaki, Reiko ; Sakuraba, Atsushi ; Kuji, Naoaki ; Miura, Soichiro ; Hibi, Toshifumi ; Suzuki, Yasuo ; Hokari, Ryota</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-7745cfa67410fc6105064f13ac435865d07d7ccc1231608c82dcb52d5baf85273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abortion, Spontaneous - diagnosis</topic><topic>Abortion, Spontaneous - epidemiology</topic><topic>Adult</topic><topic>Age</topic><topic>Analysis</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</topic><topic>Biochemistry</topic><topic>Colitis, Ulcerative - diagnosis</topic><topic>Colitis, Ulcerative - drug therapy</topic><topic>Colitis, Ulcerative - epidemiology</topic><topic>Complications and side effects</topic><topic>Drug dosages</topic><topic>Drugs</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Inflammatory bowel disease</topic><topic>Medical colleges</topic><topic>Medical research</topic><topic>Medical treatment</topic><topic>Medication Adherence</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Mesalamine - therapeutic use</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patient compliance</topic><topic>Patient outcomes</topic><topic>Physicians</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - diagnosis</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>Pregnant women</topic><topic>Premature Birth - diagnosis</topic><topic>Premature Birth - epidemiology</topic><topic>Prospective Studies</topic><topic>Questionnaires</topic><topic>Regression analysis</topic><topic>Risk factors</topic><topic>Surveys</topic><topic>Symptom Flare Up</topic><topic>Transplant Surgery</topic><topic>Tumor necrosis factor-TNF</topic><topic>Ulcerative colitis</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Watanabe, Chikako</creatorcontrib><creatorcontrib>Nagahori, Masakazu</creatorcontrib><creatorcontrib>Fujii, Toshimitsu</creatorcontrib><creatorcontrib>Yokoyama, Kaoru</creatorcontrib><creatorcontrib>Yoshimura, Naoki</creatorcontrib><creatorcontrib>Kobayashi, Taku</creatorcontrib><creatorcontrib>Yamagami, Hirokazu</creatorcontrib><creatorcontrib>Kitamura, Kazuya</creatorcontrib><creatorcontrib>Takashi, Kagaya</creatorcontrib><creatorcontrib>Nakamura, Shiro</creatorcontrib><creatorcontrib>Naganuma, Makoto</creatorcontrib><creatorcontrib>Ishihara, Shunji</creatorcontrib><creatorcontrib>Esaki, Motohiro</creatorcontrib><creatorcontrib>Yonezawa, Maria</creatorcontrib><creatorcontrib>Kunisaki, Reiko</creatorcontrib><creatorcontrib>Sakuraba, Atsushi</creatorcontrib><creatorcontrib>Kuji, Naoaki</creatorcontrib><creatorcontrib>Miura, Soichiro</creatorcontrib><creatorcontrib>Hibi, Toshifumi</creatorcontrib><creatorcontrib>Suzuki, Yasuo</creatorcontrib><creatorcontrib>Hokari, Ryota</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Watanabe, Chikako</au><au>Nagahori, Masakazu</au><au>Fujii, Toshimitsu</au><au>Yokoyama, Kaoru</au><au>Yoshimura, Naoki</au><au>Kobayashi, Taku</au><au>Yamagami, Hirokazu</au><au>Kitamura, Kazuya</au><au>Takashi, Kagaya</au><au>Nakamura, Shiro</au><au>Naganuma, Makoto</au><au>Ishihara, Shunji</au><au>Esaki, Motohiro</au><au>Yonezawa, Maria</au><au>Kunisaki, Reiko</au><au>Sakuraba, Atsushi</au><au>Kuji, Naoaki</au><au>Miura, Soichiro</au><au>Hibi, Toshifumi</au><au>Suzuki, Yasuo</au><au>Hokari, Ryota</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>66</volume><issue>2</issue><spage>577</spage><epage>586</epage><pages>577-586</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background
Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting system without physician interference.
Methods
Sixty-eight pregnant UC women were recruited from 17 institutions between 2013 and 2019. During the course of pregnancy, questionnaires were collected separately from patients and physicians, to investigate the true adherence to medications, disease activity, and birth outcomes. Multivariable logistic regression analysis was performed to identify the risk factors for the relapse or adverse pregnancy outcomes.
Results
Of 68 pregnancy, 15 adverse pregnancy outcomes occurred in 13 patients. The rate of self-reported non-adherence was the greatest to mesalamines in the first trimester, which was significantly higher than physicians’ estimate (
p
= 0.0116), and discontinuation was observed in 42.1% of non-adherent group. Logistic regression analysis revealed non-adherence as an independent risk factor for relapse [odds ratio (OR) 7.659, 95% CI 1.928–30.427,
p
= 0.038], and possibly for adverse pregnancy outcome (OR 8.378, 95% CI 1.350–51.994,
p
= 0.023). Among the subgroup of patients treated with oral mesalamine alone, the non-adherence was confirmed to be an independent risk factor for relapse (
p
= 0.002).
Conclusion
Non-adherence to mesalamine was underestimated by physicians in pregnant UC patients and contributed to disease relapse and possibly on pregnancy outcomes. Preconceptional education regarding safety of medications and risk of self-discontinuation is warranted.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32249373</pmid><doi>10.1007/s10620-020-06221-6</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2021-02, Vol.66 (2), p.577-586 |
| issn | 0163-2116 1573-2568 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2386444216 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abortion, Spontaneous - diagnosis Abortion, Spontaneous - epidemiology Adult Age Analysis Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Biochemistry Colitis, Ulcerative - diagnosis Colitis, Ulcerative - drug therapy Colitis, Ulcerative - epidemiology Complications and side effects Drug dosages Drugs Female Gastroenterology Hepatology Humans Infant, Newborn Inflammatory bowel disease Medical colleges Medical research Medical treatment Medication Adherence Medicine Medicine & Public Health Medicine, Experimental Mesalamine - therapeutic use Oncology Original Article Patient compliance Patient outcomes Physicians Pregnancy Pregnancy Complications - diagnosis Pregnancy Complications - drug therapy Pregnancy Complications - epidemiology Pregnancy Outcome - epidemiology Pregnant women Premature Birth - diagnosis Premature Birth - epidemiology Prospective Studies Questionnaires Regression analysis Risk factors Surveys Symptom Flare Up Transplant Surgery Tumor necrosis factor-TNF Ulcerative colitis Womens health |
| title | Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes |
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