Clinical management of inflammatory bowel disease from preconception to postpartum.

Abstract

Introduction: Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, often affects individuals during their peak reproductive years. Female patients with IBD face unique challenges across the reproductive years, from fertility and conception to delivery and lactation. Despite increasing awareness, knowledge gaps remain regarding optimal management during pregnancy and postpartum. This review outlines these challenges and provides a practical, evidence-based approach across reproductive stages.

Areas covered: This review summarizes care for IBD in reproductive years, including preconception counseling, pregnancy management, delivery planning, surgical and perianal disease considerations, postpartum care, breastfeeding, and infant vaccination after biologic exposure.

Expert opinion: Managing IBD from preconception through the postpartum period requires early planning, multidisciplinary coordination, and patient-centered care. Disease remission is the strongest predictor of maternal and fetal outcomes. Most IBD therapies, including biologics, are safe in pregnancy and lactation and should continue, except small molecules, which remain contraindicated due to teratogenic risk or limited safety data. Rotavirus and other vaccinations can generally be administered on schedule in infants exposed to biologics in utero. A proactive, treat-to-target strategy throughout pregnancy, combined with close postpartum monitoring, can prevent disease flares and support optimal outcomes for both mother and child.