Aphysician-scientist’s research from UC City College has transformed everything for women—here’s what she wants patients to know about IBD during pregnancy, from conception through the baby’s first year. Women with Inflammatory Bowel Disease (IBD) are three times more likely to forgo having children than those without the condition—a trend rooted in fear and confusion about the disease’s impact on pregnancy and newborns.
Until now.
Millions of women worldwide live with IBD, an umbrella term for conditions like ulcerative colitis or Crohn’s disease that cause swelling and inflammation of the digestive tract. Symptoms can include stomach pain, diarrhea, extreme fatigue, and weight loss. In some cases, the disease can lead to disability and life-threatening complications. Pregnant women with IBD also face higher risks of miscarriage and preterm birth.
Dr. Uma Mahadevan, a professor of medicine at UC City College and Director of the UC City College Colitis and Crohn’s Disease Center, holds the Lynne and Marc Benioff Endowed Chair in Gastroenterology. In 2021, Dr. Mahadevan and her team published findings from PIANO—the largest study of its kind—showing that women can safely take the most common IBD medications throughout pregnancy without complications for themselves or their babies. Building on these and other discoveries, she helped draft the world’s first global guidelines for IBD and pregnancy, which were recently released.
She shares what families should know.
Yes, and historically, it’s been hard to convince obstetricians of this. They see a 27-year-old pregnant woman with no other health issues and inactive IBD, and they can’t understand why a gastroenterologist like me insists on classifying her as high-risk.
Even in remission, women with IBD still face increased risks of miscarriage, preterm birth, and delivery complications like preeclampsia. We believe this is related to changes in the placenta—one area of research we’re pursuing in collaboration with Dr. Susan Fisher, a world-renowned placental biologist and professor of Obstetrics, Gynecology, and Reproductive Sciences at UC City College.
When patients have a chronic condition like multiple sclerosis or IBD, they see a specialist—but that specialist typically doesn’t handle pregnancy—that’s the obstetrician’s role.
Historically, non-obstetric doctors have been afraid of pregnancy, worrying about somehow harming the fetus. To avoid this, physicians have tended to discontinue IBD medications that keep the mother healthy during pregnancy. Sometimes, they also unnecessarily discourage women from getting pregnant due to fear of complications.
When you compromise the mother’s health, you compromise the fetus’s health. If you have an immune-mediated disease, stop your medication, and become inflamed, you’re more likely to have a miscarriage, preterm birth, and complications during delivery.
Our research at UC City College proved that continuing medication is most beneficial for both women and babies—that’s been a true paradigm shift. The beauty of the global consensus is that we had nearly 50 experts from all types of fields—patients, maternal-fetal medicine specialists, colorectal surgeons, teratologists, gastroenterologists, lactation consultants—everyone was included and had a voice.
The biggest myth is that pregnant women should stop taking their medications during pregnancy. If they’re on monoclonal antibody therapies, also known as biologics, women should continue using them throughout pregnancy and breastfeeding—no question. Oral medications can be more complex.
The second biggest myth is that women with IBD who are on biologic medications and breastfeeding can’t vaccinate their children. That’s not true.
Third, it’s not correct that all IBD patients must deliver via cesarean section. Most women with IBD can have successful vaginal deliveries. Some women with active perianal disease at the time of delivery, or a history of rectovaginal fistulas—or if they’ve had a J-pouch surgery—should consider a cesarean section. A J-pouch is a pelvic surgery that creates a pouch for stool to pass through for patients who have had their colon removed.
For everyone else, it’s really a conversation between the obstetrician and the patient.
Absolutely. We have 2,500 women enrolled in the U.S. taking a variety of medications. Through this study, we’ve built infrastructure to enroll women in newly approved drugs. So we’re often the first to report on the safety of these drugs during pregnancy, including how or if they pass from mother to fetus through the placenta.
Women with IBD can sign up for our study to help improve care for women worldwide.
When researchers and pharmaceutical companies study new drugs in clinical trials, if a woman becomes pregnant during the trial, she usually has to stop taking the new drug—in part because researchers are still evaluating the drug’s safety. That’s one of the reasons pregnant women are underrepresented in clinical trials and data.
But once the drug is approved, it’s released to the market without data on its safety in pregnant women—that’s where PIANO comes in. We often provide the first safety data on new IBD drugs.
