Whitney Gray

@hilarykmichel @PedsGIChat @SCKimCHP @tkazmers @xtzhang No info collected, maybe resource sheet would have been the better word choice :).I think having this information attached to the discharge paperwork routinely can let patients know that these are topics we are happy to discuss with them when they are ready

@whimorgra @PedsGIChat @SCKimCHP @tkazmers @xtzhang Amazing! What info do you collect?

Q10 What opinion from your study did participants surprise you the most as a Ped GI? How have you changed the way you educate your young adolescents and young adults on reproductive health since publishing this study? @SCKimCHP @hilarykmichel @tkazmers @whimorgra #PedsGIChat

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Our team has been working on an information sheet on women’s health in IBD that can be incorporated into the EMR (Thank you Dr. Zhang @xtzhang!)

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Most participants want their GI provider to initiate discussions around SRH as it relates to their IBD. When you practice in a subspecialty, it is sometimes a grey area about who the care should be provided by (PCP vs. Peds GI vs. Gyn in this case)

@RossMaltz @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Great question! Sulfasalazine reversibly causes oligospermia and therefore recommended to be discontinued 3-4 months before attempting conception (with alternative therapy plan established) There is some question of this for methotrexate as well, but data is limited.

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers @whimorgra What about male patients? Any medication they have to stop?

Your 17 y.o F patient just found out she’s 10 weeks pregnant. She’s in clinical remission on infliximab. She’s due for her next infliximab infusion today. She is asking if it’s safe for her and her fetus 🤱🏽and should she get her infusion?

@hilarykmichel @PedsGIChat @SCKimCHP @tkazmers The mother did today as her son asked her about it. It is more common that they bring it up, which I am always happy to talk about further so they have that information and not find something incorrect online

@whimorgra @PedsGIChat @SCKimCHP @tkazmers Did you bring it up or did the patient/families?

Q5 What is the risk of a child developing IBD if one (or both) of their parents has IBD? Do you discuss this during your office visits? @SCKimCHP @hilarykmichel @tkazmers @whimorgra #PedsGIChat #NASPGHAN #PEDSGI

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Most of the time, when patients and their families hear it is less than 10%, they feel reassured by this. I also discuss that there is currently no way to predict as the cause of IBD is multifactorial so it should not weigh heavily on your decision

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers I actually talked about this today with a family of a patient who was just diagnosed. It is less than 10% if one parent has IBD but can be higher ~1/3 chance if both parents have IBD.

@Gastro4Kids @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers It is also helpful if your patient has another diagnosis besides IBD to be able to quickly discuss recommendations taking both into consideration.

@Gastro4Kids @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Exactly! Theoretical risk based on those factors. . Therefore, we generally recommend progesterone only options. I really like the U.S. Medical Eligibility Chart for Contraceptive Use from the CDC for a quick reference (there is an app too!) cdc.gov/reproductivehe…

Q4 Is there increased risk of thrombosis with IBD patient on contraception (especially if it’s active IBD)? @SCKimCHP @hilarykmichel @tkazmers @whimorgra #PedsGIChat #NASPGHAN #PEDSGI

@temarahajjat @hilarykmichel @PedsGIChat @SCKimCHP @tkazmers @tkazmers shared with me the suggestion of asking "do you ever want to get pregnant" and that has opened the door for the conversation in older teens/young adults. This link is a great resource about having the conversation: powertodecide.org/one-key-questi… (also courtesy of @tkazmers )

@hilarykmichel @PedsGIChat @SCKimCHP @tkazmers @whimorgra How do you start that convo?

Q2 When do you start the conversation regarding fertility and reproductive health in a patient diagnosed with IBD? @SCKimCHP @hilarykmichel @tkazmers @whimorgra #PedsGIChat #NASPGHAN #PEDSGI

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Of course, it is always best to minimize steroid use. Methotrexate is an absolute contraindication and should be discontinued 3-6 months prior to trying to conceive. However, there should be clear plans on alternative therapy to keep disease under good control.

Q1 Which IBD medications are safe and which IBD medications are contraindicated in pregnancy? @SCKimCHP @hilarykmichel @tkazmers @whimorgra #PedsGIChat #NASPGHAN #PEDSGI

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Biologics are safe as well as thiopurines (We learned this from the PIANO study. Mesalamines are safe. Corticosteroids increase risk for complications such as birth defects, GDM, preterm birth but are not an absolute contraindication.

Agree! When there are different EHR systems that do not communicate the collaboration can be difficult #TweetNLearn

@CHP_APP @HMorganPedsPCPA Hi everyone! I am Whitney Gray, CRNP with GI

Hi Everyone! Happy Wednesday! Welcome to our #TweetNLearn Journal Club! I'm @HMorganPedsPCPA and I'll be your moderator tonight! So excited you'll be joining us as we discussing Integrating Children's Health into Primary Care. Let's all introduce ourselves while we get settled in