The management of inflammatory bowel disease in pregnancy

The peak incidence of inflammatory bowel disease (IBD) coincides with a woman's prime reproductive years. Pregnancy related knowledge remains suboptimal among healthcare professionals and women living with IBD. Preconception counselling can improve pregnancy specific IBD patient knowledge and provide a personalised risk assessment, to ensure optimal maternal and fetal outcomes. Although fertility rates in women with IBD are comparable with the general population, voluntary childlessness is common among women with IBD. IBD disease activity at conception and during pregnancy is a key determinant of the course of IBD during pregnancy. Active IBD during pregnancy is associated with adverse outcomes including spontaneous abortion, small for gestational age baby, and preterm birth. Most IBD medications are considered low risk during pregnancy and breastfeeding, except for methotrexate, JAK-inhibitors, ozanimod, ciclosporin, and allopurinol. Most women with IBD can have a vaginal delivery, but caesarean section should be considered in active perianal disease and history of ileal pouch surgery. We review the current evidence for preconceptual management of IBD, during pregnancy, and the postpartum period.