New guidelines set for managing IBD in pregnancy

On August 28, 2025, the Helmsley PIANO Expert Global Consensus was published in 6 international journals to provide standardized guidelines for providing care to women with inflammatory bowel disease (IBD).

The guidelines were developed based on data from the Pregnancy Inflammatory Bowel Disease And Neonatal Outcomes study, assessing the safety of IBD medications in pregnancy alongside short- and long-term offspring outcomes. These new findings include continuing all biologics throughout pregnancy and universal pre-conception counseling.

“Some of the findings were expected, but others were novel,” said Uma Mahadevan, MD, director of the Colitis and Crohn’s Disease Center at the University of California, San Francisco. “The goal of our study and consortium has been to provide hope, comfort, and the same high-level care to current and future mothers with IBD.

Key risk factors

Family history was highlighted as a vital risk factor of IBD. This is supported by a Danish study indicating a hazard ratio (HR) of 4.6 for maternal ulcerative colitis (UC) among offspring of women with IBD vs those without IBD. Additionally, maternal Crohn’s disease (CD) was linked to an HR of 7.7 for IBD development in offspring.

Investigators also noted current research about a potential link between IBD and the placenta. They noted IBD likely does not negatively impact placental development because of the organ’s vital role in normal pregnancy and pregnancy complications.

Smoking during pregnancy has also been linked to IBD, though no significant association with IBD subtypes has been observed. In a meta-analysis including 9 studies, the odds ratio (OR) for IBD in offspring of mothers who smoked during pregnancy was 1.5. This link was also found in a population-based cohort study.

An OR of 1.75 for IBD has also been reported in offspring of mothers with prenatal antibiotic use, highlighting a significant association. Very-early-onset IBD was linked to very-early-onset IBD in a population-based study, with an adjusted HR of 1.93. CD was found to increase this risk, but no link was found for UC.

Environmental factors

Investigators noted increased odds of offspring IBD when mothers present with the condition vs fathers. Therefore, they hypothesized that early environmental triggers, such as maternal diet during pregnancy, may impact IBD development. In a longitudinal birth cohort, increased food additive (FA) was reported in IBD mothers vs non-IBD mothers.

The data also highlighted significant increases in fecal calprotectin levels in the guts of infants born to mothers with greater FA intake, regardless of IBD status. This data supports the hypothesis that prenatal diet may impact offspring conditions among mothers with IBD.

Currently, only 1 human study provides data with a significant quality of evidence linking the maternal microbiome to IBD risk in offspring. Mothers with prenatal IBD maintained abnormal gut microbiota composition during pregnancy, altering offspring’s bacterial diversity and abundance of bacterial species.

This has led to research about preventing intestinal inflammation in offspring by targeting the maternal microbiome. The Modulating Early Life Microbiome through Dietary Intervention in Pregnancy trial is assessing the outcomes of this intervention in pregnant women with CD, but investigators noted long-term follow-up is necessary to validate the findings.

Implications

Highlighting all this data, investigators stressed the importance of preconception counseling. This should be conducted by an IBD care provider at least 6 months before attempting conception, beginning at IBD diagnosis among reproductive-aged women.

“We hope that this consensus statement will provide a blueprint for evidence-based management of women with IBD, from pre-conception to post-delivery,” said Millie D. Long, MD, MPH, co-chair of the Global Consensus Conference at the University of North Carolina.

References

1. First global guidelines for pregnancy and inflammatory bowel disease developed. University of California San Francisco Medical Center. August 28, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1096189.
2. Mahadevan U, Seow CH, Barned EL, et al. Global consensus statement on the management of pregnancy in inflammatory bowel disease. Clinical Gastroenterology and Hepatology. 2025. doi:10.1016/j.cgh.2025.04.005