Uma Mahadevan, MD, highlights new guidelines for managing IBD

Updated international guidelines for the management of inflammatory bowel disease (IBD) during pregnancy have been developed to unify recommendations for clinicians and improve patient care worldwide. According to Uma Mahadevan, MD, director of the UCSF Colitis and Crohn's Disease Center, these guidelines are significant because past recommendations varied by country and medical society, leading to confusion for both providers and patients. A single universal guideline now offers clear, evidence-based direction for gastroenterologists and obstetricians.

IBD affects an estimated 3 to 5 million people in the United States, with rates increasing globally. Mahadevan explained that while genetic predisposition is the primary risk factor, environmental influences such as in-utero antibiotic exposure, alterations in the gut microbiome, and immune system function also play a role in disease development.

One of the major updates emphasizes preconception counseling. Women with IBD should aim for remission before pregnancy, optimize nutritional status, and be classified as high-risk obstetric patients. In the United States, this typically involves referral to maternal-fetal medicine specialists, though in resource-limited settings, enhanced monitoring may suffice.

The guidelines also provide updated recommendations on medication use. Mahadevan highlighted that mesalamines and biologic therapies—including anti-TNF agents, IL-23 inhibitors, and anti-integrins—should be continued throughout pregnancy, a change from prior practices that often paused biologics late in gestation. Conversely, small molecule therapies such as S1P modulators and JAK inhibitors should be avoided during conception and pregnancy unless no alternatives exist.

Regarding delivery, cesarean section is recommended only for women with active perianal disease or rectovaginal fistula; otherwise, mode of delivery can be determined by the obstetrician. Women with IBD face increased risks of spontaneous abortion, preterm birth, venous thromboembolism, and labor complications, further underscoring the need for high-risk management.

Postpartum care and infant health are also addressed. Breastfeeding is considered safe for women using mesalamine, thiopurines, and biologics, but not small molecule therapies. Importantly, new data support the safe administration of the live rotavirus vaccine to infants, regardless of maternal medication. Additionally, women are advised to start low-dose aspirin between 12 and 16 weeks of pregnancy to reduce preeclampsia risk.

Mahadevan emphasized that clinicians can begin applying these guidelines by prioritizing preconception counseling, monitoring disease remission, ensuring appropriate medication use, and maintaining close follow-up. Comprehensive resources—including published recommendations, educational slide decks, and multilingual patient videos—are available at pianostudy.org to support implementation.

Disclosures: Takeda Pharmaceuticals U.S.A., Inc.

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