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Multicenter Study
. 2025 Nov 8;19(10):jjaf176.
doi: 10.1093/ecco-jcc/jjaf176.

How long is long enough? Timing of pre-conceptional remission predicts relapse risk during pregnancy in IBD

Dianne G Bouwknegt  1 , Birgit Hoekstra  1 , Hylke C Donker  2 , Bram van Es  3   4 , Henk Groen  2 , Gerard Dijkstra  1 , Willemijn A van Dop  5 , Tjebbe Tauber  3 , C Janneke van der Woude  5   6 , Marijn C Visschedijk  1 ; Dutch Initiative on Crohn and Colitis (ICC)
Collaborators, Affiliations
Multicenter Study

How long is long enough? Timing of pre-conceptional remission predicts relapse risk during pregnancy in IBD

Dianne G Bouwknegt et al. J Crohns Colitis. .

Abstract

Background and aims: Inflammatory bowel disease (IBD) often coincides with pregnancy, and disease activity during pregnancy increases the risk of adverse outcomes. We aimed to determine how disease course before conception influences relapse risk during pregnancy, adjusting for established risk factors.

Methods: In this multicenter, retrospective cohort study, we included adult women with IBD who were pregnant during treatment at one of three university hospitals between 2017 and 2022. Using generalized estimating equations, we evaluated associations between relapse during pregnancy and pre-conceptional flares, categorized into three time intervals. Analyses were adjusted for phenotype, disease duration, surgical history, biologic use, smoking, and assisted reproduction. Interaction analyses were conducted with matched non-pregnant women.

Results: We included 386 women (63.4% Crohn's disease, 36.6% ulcerative colitis) with 476 pregnancies. Pre-conceptional flares were significantly associated with relapse if they occurred <3 months [adjusted odds ratio (aOR) 5.289, 95% CI 2.6-10.8, P < .001] or 3-6 months prior to conception (aOR 2.910, 95% CI 1.0-8.2, P = .043), but not 6-12 months prior (aOR 1.636, 95% CI 0.8-3.2, P = .146). Other predictors were not significantly associated with relapse. There was no significant interaction between pregnancy and pre-conceptional disease activity.

Conclusions: This large multicenter study demonstrates that disease activity within 6 months before conception significantly increases the risk of relapse during pregnancy in women with IBD. Our study is the first to assess both the pre-conceptional disease course and a broad set of known risk factors in a real-world cohort.

Keywords: inflammatory bowel disease; pre-conception care; pregnancy; relapse.

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Conflict of interest statement

D.G.B. received speaker fees from Galapagos and Takeda. B.H. none to declare. H.C.D. receives financial support from Boehringer Ingelheim for a separate, unrelated, project, and was financially supported by MedxAI. B.v.E. none to declare. H.G. none to declare. G.D. received a grant from Royal DSM, advisory board fee from Pharmacosmos and ASTRA-ZENECA, and speakers fee from Abbvie. W.v.D. none to declare. T.T. none to declare. C.J.v.d.W. received grants from ZonMW, Falk, and Pfizer, has received consulting fees from Janssen, Galapagos, and Pfizer, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Ferring and AbbVie, and had leadership roles in the European Crohn’s & Colitis Organisation, United European Gastroenterology council, and the Dutch Association for Gastroenterology (NVGE). M.C.V. received speaker fees from Janssen-Cilag, Galapagos, and Ferring B.V.

Figures

Figure 1.
Figure 1.
Flowchart of the inclusion of patients.
See this image and copyright information in PMC

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