Managing Inflammatory Bowel Disease During Pregnancy: Insights on Treatment Efficacy and Safety

Pregnancy for women with inflammatory bowel disease (IBD) demands meticulous balancing of disease remission with fetal health. Emerging strategies are redefining how these intertwined priorities are addressed, especially as a recent global consensus provides clearer guidance.

IBD management during pregnancy requires careful adjustment to therapy, tailored to support disease remission while ensuring safety. As reflected in a recent global consensus, maintaining consistent therapy is crucial to reducing disease flares that can affect both mother and child. Safety profiles for anti-TNF agents and thiopurines support uninterrupted care when indicated, while teratogens like methotrexate remain contraindicated.

Building on the recent ECCO consensus, established safety data for key IBD medications support uninterrupted treatment when needed. Addressing in utero medication exposure, most data in the do not show increased rates of major congenital anomalies or adverse birth outcomes with anti-TNF agents or thiopurines; however, infants exposed to biologics typically require delayed live vaccines.

From the patient experience lens, accounts of continuing anti-TNFs or thiopurines through pregnancy echo observational data on healthy births and postpartum disease control; decisions are individualized with close monitoring and planning for infant vaccines after in utero biologic exposure.

Transitioning from data to practice, many clinicians are adapting their approaches in line with recent consensus recommendations. Clinicians often emphasize that disease remission before conception is one of the strongest predictors of favorable outcomes. In practice, this means confirming stability on current therapy rather than switching medications late in pregnancy unless safety concerns arise. The ECCO-aligned approach also encourages shared decision-making to weigh flare risks against theoretical fetal exposures, acknowledging that uncontrolled inflammation itself can increase risks of preterm birth and low birth weight.