Systematic Review With Meta-analysis

Risk of Adverse Pregnancy-related Outcomes in Inflammatory Bowel Disease

Parul Tandon; Vivek Govardhanam; Kristel Leung; Cynthia Maxwell; Vivian Huang


Aliment Pharmacol Ther. 2020;51(3):320-333. 

In This Article

Abstract and Introduction


Background: The effect of inflammatory bowel disease (IBD) on pregnancy-related outcomes remains unknown.

Aim: To determine the risk of adverse maternal, placental and obstetric outcomes in IBD

Methods: We searched Medline, Embase and Cochrane library through May 2019 for studies reporting adverse maternal, placental and obstetric outcomes in patients with IBD. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for these outcomes in patients with IBD compared to healthy controls.

Results: Fifty-three studies were included (7917 IBD pregnancies and 3253 healthy control pregnancies). Caesarean delivery was more common in patients with IBD compared to healthy controls (OR 1.79, 95% CI, 1.16–2.77). This remained significant for UC (OR 1.80, 95% CI, 1.21–2.90) but not CD (OR 1.48, 95% CI, 0.94–2.34). Similarly, gestational diabetes occurred more commonly in IBD (OR 2.96, 95% CI, 1.47–5.98). The incidences of placental diseases were 2.0% (95% CI, 0.9%-3.1%) for pre-eclampsia, 3.3% (95% CI, 0%-7.2%) for placental abruption, 0.5% (95% CI, 0.2%-0.9%) for placenta previa and 0.3% (95% CI, 0%-0.5%) for chorioamnionitis. Patients with IBD were more likely to experience preterm prelabour rupture of membranes (OR 12.10, 95% CI, 2.15–67.98), but not early pregnancy loss (OR 1.63, 95% CI 0.49–5.43). Anti-tumour necrosis factor therapy was not associated with chorioamnionitis (OR 1.12, 95% CI, 0.16–7.67), early pregnancy loss (OR 1.49, 95% CI, 0.83–2.64) or placenta previa (OR 1.58, 95% CI, 0.30–8.47).

Conclusions: Gestational diabetes and preterm prelabour rupture of membranes occurs more commonly in patients with IBD, although the incidence of placental diseases remains low.


Inflammatory bowel disease (IBD) is a chronic inflammatory condition that can be further classified as Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified.[1] The peak onset of the disease occurs between 15 and 30 years of age,[2] with 50% of patients diagnosed before the age of 35.[3] Furthermore, over 25% of patients become pregnant after a diagnosis of IBD, representing a high-risk population at risk of potential adverse pregnancy outcomes.[3]

In fact, several studies have reported increased rates of elective and emergent delivery via caesarean section (C-section) in patients with IBD,[4–7] particularly in those with active perianal CD or those with UC post-ileal pouch-anal anastomosis. Similarly, others have demonstrated an increased risk of metabolic disorders such as gestational diabetes[6,8] and structural disorders such as ectopic pregnancy,[9] although these risks remain controversial.

More recently, the risk of ischaemic and non-ischaemic placental disorders in patients with IBD has been explored by a small number of studies. Placental-related diseases, such as pre-eclampsia, placenta previa and placental abruption, are associated with an increased risk of maternal and neonatal morbidity, such as small for gestational age (SGA), intra-uterine growth restriction and even foetal mortality.[10] Although recent studies have suggested an increased risk of these disorders in patients with IBD, the study sample sizes remain small and the specific risk factors remain to be elucidated.

As such, the aim of this systematic review and meta-analysis was to determine the risk of maternal-, placental- and obstetric-related pregnancy outcomes in patients with IBD. Furthermore, specific risk factors for these outcomes, such as disease activity and medication exposure, were explored.