{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T03:10:24Z","timestamp":1774408224169,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Inflammatory bowel disease (IBD) frequently manifests at a young age, during the peak fertility years. Understanding the risks of negative pregnancy outcomes associated with IBD is crucial for effective pregnancy management and support. Additionally, it is essential to provide patients with the necessary knowledge to make informed choices and foster their confidence in navigating pregnancy while maintaining effective disease management. Although IBD frequently appears during the peak fertility years, knowledge about managing pregnancy in the context of IBD remains limited and often inaccurate among both physicians and patients. Our study aims to assess the complications occurring during pregnancy in patients with IBD, considering the level of disease activity, and to evaluate the standard of care provided to patients with chronic inflammatory conditions through a cohort analysis. Methods: Patients with IBD who had children were included in this single-center mixed-method (retrospective and prospective) study. Clinical data, disease progression, course of pregnancy, and complications were examined in women. Outcomes for children of men with IBD were also analyzed. To supplement the data, a survey addressing various pregnancy-related topics, including all patients from the university outpatient clinic for IBD, was conducted over a period of six months. Results: A total of 410 patients were screened retrospectively between 2010 and 2021. In total, 134 patients who had children were included in the study: 51.4% (n = 69) had Crohn\u2019s disease, 44% (n = 59) had ulcerative colitis, and 4.6% (n = 6) had unclassified inflammatory bowel disease. Of the women, 85% (n = 34) were in remission for at least three months before pregnancy, 14.6% (n = 6) experienced an acute flare-up during pregnancy, and 10.3% (n = 4) and 7.7% (n = 3) had active disease at the time of delivery and during breastfeeding, respectively. Patients with IBD who were in remission before pregnancy did not experience a higher risk of pregnancy complications (no cases of pre-eclampsia or placental abruption were reported in this group). However, the rates of gestational diabetes and fever during pregnancy were 10% for those in remission, compared to 25% for those with active disease. Conclusions: Patients with IBD in remission did not present an increased risk of pregnancy complications. However, our survey indicates that those with active disease at conception were more likely to experience complications such as gestational diabetes and fever. These findings underscore the importance of adequate patient education regarding the safety of various IBD medications during pregnancy in order to avoid pregnancy-related complications.<\/jats:p>","DOI":"10.3390\/jcm13247710","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T03:40:56Z","timestamp":1734493256000},"page":"7710","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pregnancy in Inflammatory Bowel Disease: Data from a Real-World Cohort in Germany"],"prefix":"10.3390","volume":"13","author":[{"given":"Mousa","family":"Ayoub","sequence":"first","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-8006","authenticated-orcid":false,"given":"Anna","family":"Muzalyova","sequence":"additional","affiliation":[{"name":"Digital Medicine, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alanna","family":"Ebigbo","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Nagl","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"R\u00f6mmele","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2611-6074","authenticated-orcid":false,"given":"Johanna","family":"Classen","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Wanzl","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology, Klinikum N\u00fcrnberg, 90419 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Internal Medicine I, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vidan","family":"Tadic","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Schlottmann","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Schnoy","sequence":"additional","affiliation":[{"name":"Internal Medicine III, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"ref_1","first-page":"33","article-title":"Inflammatory bowel disease: An expanding global health problem","volume":"6","year":"2013","journal-title":"Clin. Med. Insights. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3748\/wjg.v20.i1.91","article-title":"Inflammatory bowel disease: Pathogenesis","volume":"20","author":"Zhang","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/apt.12417","article-title":"Meta-analysis: The impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease","volume":"38","author":"Abhyankar","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_4","first-page":"96","article-title":"Pregnancy and Inflammatory Bowel Disease","volume":"11","author":"Hashash","year":"2015","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1002\/ibd.20082","article-title":"Voluntary childlessness is increased in women with inflammatory bowel disease","volume":"13","author":"Marri","year":"2007","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"goac055","DOI":"10.1093\/gastro\/goac055","article-title":"Pregnancy and Crohn\u2019s disease: Concerns and assurance of medical therapy","volume":"10","author":"Chowdhury","year":"2022","journal-title":"Gastroenterol. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s00404-020-05557-8","article-title":"Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases","volume":"301","author":"Rottenstreich","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0020-7292(97)00088-X","article-title":"Fertility and pregnancy in inflammatory bowel disease","volume":"58","author":"Hudson","year":"1997","journal-title":"Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1136\/bmj.39566.681458.BE","article-title":"Neil Inflammatory bowel disease in pregnancy","volume":"337","author":"Ferguson","year":"2008","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1053\/j.gastro.2022.06.068","article-title":"CORE-IBD: A Multidisciplinary International Consensus Initiative to Develop a Core Outcome Set for Randomized Controlled Trials in Inflammatory Bowel Disease","volume":"163","author":"Ma","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1572-0241.2004.04140.x","article-title":"The effect on the fetus of medications used to treat pregnant inflammatory bowel-disease patients","volume":"99","author":"Moskovitz","year":"2004","journal-title":"Am. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1159\/000016937","article-title":"Inflammatory bowel disease and pregnancy: A review","volume":"17","author":"Jospe","year":"1999","journal-title":"Dig. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1053\/j.gastro.2015.12.003","article-title":"The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy","volume":"150","author":"Nguyen","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/S0368-2315(05)82883-2","article-title":"Inflammatory bowel disease and pregnancy: Report of 76 cases and review of the literature","volume":"34","author":"Beniada","year":"2005","journal-title":"J. Gynecol. Obstet. Biol. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/j.1365-2036.2005.02384.x","article-title":"Impact of pregnancy on the clinical activity of Crohn\u2019s disease","volume":"21","author":"Agret","year":"2005","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1097\/MIB.0000000000001136","article-title":"Fecal Calprotectin Is Not Affected by Pregnancy: Clinical Implications for the Management of Pregnant Patients with Inflammatory Bowel Disease","volume":"23","author":"Julsgaard","year":"2017","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4292\/wjgpt.v9.i1.1","article-title":"Monitoring inflammatory bowel disease during prenancy: Current literature and future challenges","volume":"9","author":"Choden","year":"2018","journal-title":"World J. Gastrointest. Pharmacol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Boyd, H.A., Basit, S., Harps\u00f8e, M.C., Wohlfahrt, J., and Jess, T. (2015). Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129567"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/ibd.21400","article-title":"Sandborn, Short CDAI: Development and validation of a shortened and simplified Crohn\u2019s disease activity index","volume":"17","author":"Thia","year":"2011","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1002\/ibd.20520","article-title":"Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis","volume":"14","author":"Lewis","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/apt.12833","article-title":"Factors associated with pregnancy outcome in anti-TNF treated women with inflammatory bowel disease","volume":"40","author":"Seirafi","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3109\/00365521.2013.879200","article-title":"Influence of medical treatment, smoking and disease activity on pregnancy outcomes in Crohn\u2019s disease","volume":"49","author":"Julsgaard","year":"2014","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/s41575-023-00758-3","article-title":"Inflammatory bowel disease in pregnancy and breastfeeding","volume":"20","author":"Brondfield","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/S0140-6736(24)00052-7","article-title":"Updates on the management of inflammatory bowel disease from periconception to pregnancy and lactation","volume":"403","author":"Nielsen","year":"2024","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/apt.12949","article-title":"Review article: The management of Crohn\u2019s disease and ulcerative colitis during pregnancy and lactation","volume":"40","author":"Schulze","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/ecco-jcc\/jjv234","article-title":"Anti-Tumor Necrosis Factor \u03b1 Therapies and Inflammatory Bowel Disease Pregnancy Outcomes: A Meta-analysis","volume":"10","author":"Shihab","year":"2016","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Caballero-Mateos, A.M., Quesada-Caballero, M., La Ca\u00f1adas-De Fuente, G.A., Caballero-V\u00e1zquez, A., and Contreras-Chova, F. (2023). IBD and Motherhood: A Journey through Conception, Pregnancy and Beyond. J. Clin. Med., 12.","DOI":"10.20944\/preprints202308.1825.v1"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.reprotox.2003.10.007","article-title":"Pregnancy outcome after first trimester exposure to corticosteroids: A prospective controlled study","volume":"18","author":"Gur","year":"2004","journal-title":"Reprod. Toxicol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101777","DOI":"10.1016\/j.jogoh.2020.101777","article-title":"Reproduction and Pregnancy in Inflammatory Bowel Disease\u2014Management and Treatment Based on Current Guidelines","volume":"50","author":"Kisielewski","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s40265-020-01346-4","article-title":"Safety of New Biologics (Vedolizumab and Ustekinumab) and Small Molecules (Tofacitinib) During Pregnancy: A Review","volume":"80","author":"Gisbert","year":"2020","journal-title":"Drugs"},{"key":"ref_31","first-page":"537","article-title":"Efficacy of Ustekinumab in the Treatment of Patients with Crohn\u2019s Disease with Failure to Previous Conventional or Biologic Therapy: A Prospective Observational Real-Life Study","volume":"72","author":"Miranda","year":"2021","journal-title":"J. Physiol. Pharmacol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s10620-021-06932-4","article-title":"Effectiveness and Safety of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","volume":"67","author":"Honap","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1136\/gut.2010.222893","article-title":"Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: Cohort from the CESAME Study","volume":"60","author":"Coelho","year":"2011","journal-title":"Gut"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.dld.2023.08.054","article-title":"New drugs for the treatment of IBD during conception, pregnancy, and lactation","volume":"56","author":"Pugliese","year":"2024","journal-title":"Dig. Liver Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S888","DOI":"10.14309\/01.ajg.0000954284.23560.b8","article-title":"S1161 Pregnancy Outcomes in the Ozanimod Clinical Development Program in Patients with Ulcerative Colitis, Crohn\u2019s Disease, and Relapsing Multiple Sclerosis","volume":"118","author":"Dubinsky","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1136\/flgastro-2019-101371","article-title":"IBD in pregnancy: Recent advances, practical management","volume":"12","author":"Selinger","year":"2020","journal-title":"Frontline Gastroenterol."},{"key":"ref_37","first-page":"514","article-title":"Maladie chronique inflammatoire de l\u2019intestin et grossesse: De la conception \u00e0 la naissance [IBD and pregnancy: From conception to birth]","volume":"48","author":"Foulon","year":"2020","journal-title":"Gynecol. Obs. Fertil. Senol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Nielsen, O.H., Loftus, E.V., and Jess, T. (2013). Safety of TNF-\u03b1 inhibitors during IBD pregnancy: A systematic review. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-174"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/codi.16123","article-title":"The impact of the ileoanal pouch on female fertility in ulcerative colitis: A systematic review and meta-analysis","volume":"24","author":"Sriranganathan","year":"2022","journal-title":"Color. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lever, G., Chipeta, H., Glanville, T., and Selinger, C. (2022). Risk of Adverse Pregnancy Outcomes for Women with IBD in an Expert IBD Antenatal Clinic. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102919"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/ibd\/izz037","article-title":"Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report from the American Gastroenterological Association IBD Parenthood Project Working Group","volume":"25","author":"Mahadevan","year":"2019","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1136\/gutjnl-2019-318263","article-title":"Modulation of cytokine patterns and microbiome during pregnancy in IBD","volume":"69","author":"Binyamin","year":"2020","journal-title":"Gut"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ecco-jcc\/jjac115","article-title":"European Crohn\u2019s and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation","volume":"17","author":"Torres","year":"2023","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1007\/s10620-020-06480-3","article-title":"Identifying Patient Priorities for Preconception and Pregnancy Counseling in IBD","volume":"66","author":"Aboubakr","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1093\/ibd\/izad059","article-title":"Time to Diagnosis and Birth Outcomes of Pregnancy-onset IBD","volume":"30","author":"Vestergaard","year":"2024","journal-title":"Inflamm. Bowel Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7710\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:54:13Z","timestamp":1760115253000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7710"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,17]]},"references-count":45,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247710"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247710","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,17]]}}}