How long is long enough? Timing of pre-conceptional remission predicts relapse risk during pregnancy in IBD - Report - MDSpire

How long is long enough? Timing of pre-conceptional remission predicts relapse risk during pregnancy in IBD

  • By

  • Dianne G Bouwknegt

  • Birgit Hoekstra

  • Hylke C Donker

  • Bram van Es

  • Henk Groen

  • Gerard Dijkstra

  • Willemijn A van Dop

  • Tjebbe Tauber

  • C Janneke van der Woude

  • Marijn C Visschedijk

  • Dutch Initiative on Crohn and Colitis (ICC)

  • Alexander Bodelier

  • Lauranne Derikx

  • Willemijn van Dop

  • Marjolijn Duijvestein

  • Noortje Festen

  • Herma Fidder

  • Rogier Goetgebuer

  • Carmen Horjus

  • Jeroen Jansen

  • Bindia Jharap

  • Vincent de Jonge

  • Mark Löwenberg

  • Nofel Mahmmod

  • Sander van der Marel

  • Wout Mares

  • Peter Mensink

  • Andrea van der Meulen

  • Zlatan Mujagic

  • Loes Nissen

  • Liekele Oostenburg

  • Marieke Pierik

  • Tessa Römkens

  • Fiona van Schaik

  • Xavier Smeets

  • Marijn Visschedijk

  • Michael van der Voorn

  • Philip Voorneveld

  • Annemarie de Vries

  • Rachel West

  • Egbert-Jan van der Wouden

  • October 13, 2025

  • 0 min

Share

Optimal Pre-Conception Remission Duration Reduces IBD Relapse Risk in Pregnancy

Overview

This multicenter retrospective cohort study of 386 women with inflammatory bowel disease (IBD) found that disease activity within 6 months before conception significantly increases the risk of relapse during pregnancy. Pre-conceptional flares occurring less than 3 months before conception were associated with a fivefold increased relapse risk, while flares 3-6 months prior also elevated risk, but flares 6-12 months prior did not.

Background

Inflammatory bowel disease often affects women of reproductive age, and disease activity during pregnancy is linked to adverse outcomes such as prematurity and low birth weight. Maintaining disease remission before conception is recommended to improve pregnancy outcomes, but the optimal duration of remission prior to conception has been unclear. Previous guidelines suggest at least 3 months of steroid-free remission, yet few studies have rigorously evaluated the timing of pre-conception flares and their impact on relapse risk during pregnancy.

Data Highlights

Pre-Conception Flare IntervalAdjusted Odds Ratio (aOR)95% Confidence IntervalP-value
<3 months before conception5.2892.6 - 10.8<0.001
3-6 months before conception2.9101.0 - 8.20.043
6-12 months before conception1.6360.8 - 3.20.146

Key Findings

  • Disease flares occurring within 3 months before conception increased relapse risk during pregnancy by over fivefold (aOR 5.289).
  • Flares 3-6 months prior to conception also significantly increased relapse risk (aOR 2.910), though to a lesser extent.
  • Flares occurring 6-12 months before conception were not significantly associated with relapse risk (aOR 1.636, P=0.146).
  • Other factors such as disease phenotype, duration, surgical history, biologic use, smoking, and assisted reproduction were not significantly linked to relapse risk during pregnancy.
  • No significant interaction was found between pregnancy status and pre-conception disease activity when compared to matched non-pregnant controls.

Clinical Implications

These findings underscore the importance of achieving and maintaining disease remission for at least 6 months prior to conception to minimize relapse risk during pregnancy in women with IBD. Clinicians should prioritize pre-conception counseling and optimize disease control well before pregnancy planning. Monitoring and managing disease activity in the months leading up to conception can improve maternal and fetal outcomes.

Conclusion

This study provides robust evidence that disease activity within 6 months before conception significantly elevates relapse risk during pregnancy in women with IBD. Establishing a remission period of at least 6 months prior to conception may be critical for reducing pregnancy-related disease flares.

References

  1. Original Article 2024 -- Assessing the Optimal Duration of Pre-Conception Remission and Its Impact on Relapse Risk in Pregnant Women with Inflammatory Bowel Disease

Original Source(s)

How long is long enough? Timing of pre-conceptional remission predicts relapse risk during pregnancy in IBD

  • by Dianne G Bouwknegt, Birgit Hoekstra, Hylke C Donker, Bram van Es, Henk Groen, Gerard Dijkstra, Willemijn A van Dop, Tjebbe Tauber, C Janneke van der Woude, Marijn C Visschedijk, Dutch Initiative on Crohn and Colitis (ICC), Alexander Bodelier, Lauranne Derikx, Willemijn van Dop, Marjolijn Duijvestein, Noortje Festen, Herma Fidder, Rogier Goetgebuer, Carmen Horjus, Jeroen Jansen, Bindia Jharap, Vincent de Jonge, Mark Löwenberg, Nofel Mahmmod, Sander van der Marel, Wout Mares, Peter Mensink, Andrea van der Meulen, Zlatan Mujagic, Loes Nissen, Liekele Oostenburg, Marieke Pierik, Tessa Römkens, Fiona van Schaik, Xavier Smeets, Marijn Visschedijk, Michael van der Voorn, Philip Voorneveld, Annemarie de Vries, Rachel West, Egbert-Jan van der Wouden

  • October 13, 2025

Related Content

Metabolic and Structural Alterations Linked to Mice's Vulnerability to Primary Echinostoma caproni Infections

Combo Therapy for Psoriasis With Obesity

A phase 3b trial tests ixekizumab plus tirzepatide in adults with moderate-to-severe plaque psoriasis and obesity or overweight.

Renal Conditions Associated with Inflammatory Bowel Disease: Exploring Clinical Links, Shared Mechanisms, and Management Approaches