Is there a need for sub-specialist pregnancy clinics for women with inflammatory bowel disease (IBD)? The imapct of attendance at and geographic variation in access to the dedicated IBD pregnancy clinics in Alberta, Canada
Notice bibliographique
Résumé
Inflammatory bowel disease (IBD) is commonly diagnosed during the childbearing years.1,2 Women with IBD have increased risks of adverse pregnancy and infant outcomes, and these risks are increased with active disease at conception, as this doubles the risk of disease relapse during pregnancy.3–6 Suboptimal knowledge and misperceptions on the impact of IBD on pregnancy may result in poor decision making, resulting in worsening of outcomes.7–9 Preconception counselling from dedicated IBD pregnancy clinics have been shown to increase IBD-specific pregnancy knowledge and improve IBD management during pregnancy.10,11Using five population-based administrative health care databases linked by unique maternal and neonatal identification numbers in Alberta, we found that approximately 30% of pregnant women with IBD attended a dedicated IBD pregnancy clinic. Women were more likely to attend if they resided in close vicinity to the first established clinic, were nulliparous, had a disease flare prior to pregnancy, and were on any maintenance IBD medications. Propensity score weights were used to adjust for baseline covariates and evaluate the impact of attendance on IBD-specific, pregnancy, and infant outcomes. Despite increased odds of active disease and IBD-related emergency department (ED) visits during pregnancy in women who attended the clinic compared to women who did not attend, there was no difference in postpartum disease activity or IBD-related ED visit on clinic attendance and infants born to mothers who attended had better health status at birth. Increased risk of scheduled caesarean delivery in women who attended the clinic may reflect the complex phenotype of women requiring sub-specialty care.Using geospatial analyses, we identified geographic disparities in maternal characteristics, adverse pregnancy outcomes, attendance at an IBD pregnancy clinic, the proportion of reproductive-aged women with IBD living in a given area, and local geographic access to gastroenterologists or obstetricians/gynecologists. Location-allocation analysis identified three potential locations for satellite IBD pregnancy clinics in the North and South Alberta Health Services (AHS) Zones to decrease travelling time for reproductive-aged women with IBD. Further work, however, is needed to identify the most optimal health care delivery model (e.g., telemedicine) with limited health care resources in these geographic regions.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».