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

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Clinical Scorecard: Assessing the Optimal Duration of Pre-Conception Remission and Its Impact on Relapse Risk in Pregnant Women with Inflammatory Bowel Disease

At a Glance

CategoryDetail
ConditionInflammatory Bowel Disease (IBD) in pregnancy
Key MechanismsActive disease causes malabsorption, weight loss, vitamin D deficiency, and gut dysbiosis leading to adverse pregnancy outcomes
Target PopulationPregnant women with Crohn’s disease or ulcerative colitis
Care SettingUniversity hospital outpatient and inpatient care during pregnancy

Key Highlights

  • Pre-conceptional disease flares within 6 months before conception significantly increase relapse risk during pregnancy.
  • Flares <3 months before conception have the highest adjusted odds ratio (aOR 5.289) for relapse during pregnancy.
  • Other factors such as phenotype, disease duration, biologic use, smoking, and assisted reproduction were not significantly associated with relapse.

Guideline-Based Recommendations

Diagnosis

  • Assess disease activity status prior to conception using clinical and laboratory parameters.
  • Exclude pregnancies ending before 12 weeks for accurate disease activity assessment.

Management

  • Aim for steroid-free remission for at least 3 months before conception as recommended by the American Gastroenterological Association.
  • Maintain adequate disease control during pregnancy to reduce risk of adverse outcomes.
  • Consider multidisciplinary care involving gastroenterologists and obstetricians.

Monitoring & Follow-up

  • Monitor disease activity closely during pregnancy, especially if pre-conception flares occurred within 6 months.
  • Use clinical follow-up and possibly biomarkers to detect relapse early.

Risks

  • Active IBD during pregnancy increases risk of prematurity, low birth weight, and small for gestational age infants.
  • Disease activity may impair maternal weight gain and nutrient absorption, contributing to adverse outcomes.

Patient & Prescribing Data

Adult women with Crohn’s disease or ulcerative colitis who are pregnant or planning pregnancy

Maintaining remission for at least 3 months before conception reduces relapse risk; biologic use and prior surgery were not significantly associated with relapse risk in this cohort.

Clinical Best Practices

  • Ensure disease remission for a minimum of 3 months before conception to minimize relapse risk during pregnancy.
  • Adjust treatment plans based on individual disease activity and pregnancy status.
  • Educate patients on the importance of disease control prior to and during pregnancy.
  • Coordinate care among gastroenterology and obstetrics teams for optimal maternal and fetal outcomes.

References

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

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