IBD and Pregnancy: New Guidelines Offer Hope

Women with inflammatory bowel disease (IBD) are three times more likely to forgo having children than those without the condition – a trend fueled by fear and confusion about how the disease might impact their pregnancies and newborns.

But that’s changing now.

Millions of women worldwide live with IBD, a term encompassing conditions like ulcerative colitis and Crohn’s disease. These cause swelling and inflammation in the digestive tract. Symptoms can include stomach pain, diarrhea, extreme fatigue, and weight loss. In some cases, IBD can lead to disability and life-threatening complications.pregnant people with IBD also face a higher risk of miscarriage and preterm birth.

Uma Mahadevan, MD, is a Professor of Medicine at UCSF and the director of the Colitis and Crohn’s disease Center at UCSF. She also holds the Lynne and Marc Benioff Endowed Chair in Gastroenterology.

In 2021, Mahadevan and her team published the results of PIANO, the largest study of its kind. It demonstrated that women could safely continue taking common IBD medications throughout pregnancy without harming themselves or their babies. Building on these and othre findings, Mahadevan helped create the world’s first guidelines on IBD and pregnancy, recently released.

She shares what families need to know.

Are women with IBD considered high-risk pregnancies?

yes, and it’s historically been arduous to convince obstetricians of this. They often see a 27-year-old pregnant woman with no other medical issues, or in IBD remission, and struggle to understand why gastroenterologists like myself insist she be treated as a high-risk pregnancy.

Even in remission, women with IBD still have increased risks of miscarriage, preterm birth, and complications during labor and delivery, like preeclampsia. We believe this relates to changes in the placenta, and that’s one area we’re actively studying.