October 2025
Global consensus sets new standards for managing pregnancy in women with IBD
Dr Sasha Ellery BM BCh
A new international consensus statement sets out evidence-based recommendations for managing pregnancy in women with inflammatory bowel disease (IBD), emphasising that maintaining maternal health is central to ensuring optimal outcomes for both mother and child.
The guideline, published in Gut, included expert consensus statements and recommendations covering fertility, preconception counselling, medication use, delivery and infant care. The overarching principle was that disease control during pregnancy outweighed the risks of most approved therapies.
Adjunct Associate Professor Sally Bell, Director of Gastroenterology at Monash Health and Member of the Global Consensus Group for Pregnancy and IBD, explained that, ‘We’ve started to understand that active disease and inflammation in pregnancy is a bad thing. What the guidelines have focused on is trying to move people away from worrying about the drugs to thinking about the disease, and this is a big mental mind shift.’
The panel highlighted that women with IBD often lacked adequate counselling, with studies showing almost half had poor pregnancy-related knowledge and many expressed fears about medication safety. These gaps contributed to higher rates of voluntary childlessness compared with the general population. The new consensus recommended preconception counselling for women with IBD.
‘It’s important to have had this conversation before [these women] get pregnant, because if you do that, disease activity during pregnancy is much lower,’ Adjunct Associate Professor Bell told Medicine Today.
Strong recommendations also included continuation of maintenance 5-aminosalicylate therapy and antitumour necrosis factor therapy throughout pregnancy. Sulfasalazine, corticosteroids (when clinically necessary), thiopurines, vedolizumab and ustekinumab were also considered safe in those who were pregnant or attempting to conceive.
‘Large molecules don’t cross the placenta until about week 18, so they don’t influence teratogenicity, and the safety data suggest they don’t impact growth or development in the last half of the pregnancy either. So we now recommend to continue them all the way through,’ Adjunct Associate Professor Bell said.
In contrast, methotrexate was strongly contraindicated, and the use of Janus kinase inhibitors or sphingosine-1-phosphate receptor modulators was not recommended during pregnancy.
The group advised that pregnancies in women with IBD be treated as high risk, with close monitoring for nutritional status, micronutrient deficiencies and venous thromboembolism. Adjunct Associate Professor Bell stressed that symptoms were not a reliable way to recognise disease flare in pregnancy.
She said the key was to use objective measures. ‘A simple objective measure that GPs can order is faecal calprotectin.’ She added that intestinal ultrasound was another option, although less widely available.
For infants, the consensus recommended routine administration of inactivated vaccines regardless of maternal therapy, and the live, attenuated rotavirus vaccine could be given to those exposed to biologics in utero. In contrast, the live Bacillus Calmette-Guérin vaccine should be avoided in the first six months of life in children exposed to antitumour necrosis factor agents in utero due to the risk of disseminated tuberculosis.
Adjunct Associate Professor Bell said this consensus offered clear, evidence-based guidance for GPs.
‘[Pregnant women with IBD] shouldn’t stop any medication without discussing with the person’s gastroenterologist, and if they’re at all worried, they should reach out to one of the pregnancy and IBD services.’
For further information, Associate Professor Bell referred GPs to the Gastroenterology Society of Australia’s brochure on IBD in pregnancy, available via https://www.gesa.org.au/resources/clinical-practiceresources/.