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. 2025 Apr 22;7(2):otaf029.
doi: 10.1093/crocol/otaf029. eCollection 2025 Apr.

Pregnant Pause? Not for IBD Care-A Single Tertiary Care Center Prospective Cohort Study Affirming IBD Management in Pregnancy

Elizabeth Squirell  1 , Gregory Rosenfeld  2 , Brian Bressler  2 , Susanna Meade  3 , Natasha Klemm  4 , Victoria Chen  4 , Elisabet Joa  5 , Yvette Leung  2
Affiliations

Pregnant Pause? Not for IBD Care-A Single Tertiary Care Center Prospective Cohort Study Affirming IBD Management in Pregnancy

Elizabeth Squirell et al. Crohns Colitis 360. .

Abstract

Background: This study examined Inflammatory Bowel Disease (IBD) management and outcomes during pregnancy in a tertiary care setting, focusing on disease activity, medication use, and maternal and neonatal outcomes.

Methods: A prospective cohort study followed 287 women with IBD through 291 pregnancies from 2017 to 2023 at a single tertiary care center, collecting data preconception, during each trimester, and postpartum.

Results: The study observed a 92.7% live birth rate. Seventy-four percent of individuals were in clinical remission preconception, and disease activity increased throughout pregnancy, particularly in ulcerative colitis (UC) patients (peaking at 37% in the second trimester), while remaining stable in CD patients. UC, disease duration <5 years, and preconception activity correlated with higher disease activity during pregnancy. Biologic use remained stable without significant impact on outcomes. Preterm delivery (6.7%) and small for gestational age infants (7%) rates reflected baseline population risk. Steroid use was associated with higher preterm delivery rates. Gestational hypertension (6.9%) and diabetes (9.4%) rates were similar to population norms. Maternal adverse events were higher in women 40 or older (OR 3.893).

Conclusions: This study reaffirms the safety of continued medical therapy for IBD throughout pregnancy in a tertiary care, prospective cohort. Increased disease activity throughout pregnancy was evident, particularly in UC. Despite higher rates of disease activity amongst those with UC, outcomes were similar in those with CD vs UC-suggesting that disease activity measures have limitations in CD and pregnancy, or there is some mild inherent risk of CD in pregnancy outcomes irrespective of disease activity.

Keywords: Crohn’s; IBD; epidemiology; pregnancy; ulcerative colitis.

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Conflict of interest statement

E.S. has received honoraria from AbbVie; B.B. has been an advisor and/or speaker for AbbVie, Allergan, Amgen, Celgene, Ferring Pharmaceuticals, Genentech, Janssen, Merck, Microbiome Insights, Pendopharm, Pfizer, Protagonist, Shire, and Takeda; has received research support from AbbVie, Alvine, Amgen, Atlantic Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Genentech, GSK, Janssen, Merck, Qu Biologic, RedHill Biopharma, and Takeda; and holds stock options in Qu Biologic; Y.L. has received honoraria for Advisory Board participation and speaker fees from Janssen, Abbvie, Takeda, Pfizer, and Merck; G.R. has received honoraria from Abbvie, Frensius-Kabi, Janssen, Pfizer, Takeda, Merck, Amgen, Viatris, Organon and Ferring as a speaker, adviser and consultant. Research Grant support from Abbvie, Fresnius-Kabi, Ferring and Crohn’s and Colitis Canada. SM, NK, VC, and EJ have no conflicts to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Rate of active and severe Crohn’s disease across pregnancy stages.
Figure 2.
Figure 2.
Rate of active and severe UC across pregnancy stages.
See this image and copyright information in PMC

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