Influence of pregnancy on outcomes of inflammatory bowel disease and treatment discontinuation

doi:10.3748/wjg.120573

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 21, 2026; 32(43): 120573
Published online Nov 21, 2026. doi: 10.3748/wjg.120573

Influence of pregnancy on outcomes of inflammatory bowel disease and treatment discontinuation

Oguz Ozturk, Muhammed Bahaddin Durak, Yavuz Cagir, Mucahit Ergul, Emir Tugrul Keskin, Eren Yilmaz, Kadir Can Acun, Ali Atay, Ilhami Yuksel

Oguz Ozturk, Mucahit Ergul, Emir Tugrul Keskin, Eren Yilmaz, Kadir Can Acun, Ali Atay, Ilhami Yuksel, Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara 06800, Türkiye

Muhammed Bahaddin Durak, Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06120, Türkiye

Yavuz Cagir, Department of Gastroenterology, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara 06105, Türkiye

Ilhami Yuksel, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06800, Türkiye

Author contributions: Ozturk O, Durak MB, Cagir Y, Ergul M, Keskin ET, Yilmaz E, Acun KC, Atay A, and Yuksel I performed the data collection; Ozturk O and Yuksel I conceptualized the study, planned the design of the study, performed data analysis, interpreted the data, and drafted the manuscript. All authors revised and approved the final version of the manuscript to be submitted.

AI contribution statement: To ensure clarity, grammatical accuracy, and fluency in academic English, we used DeepL and QuillBot solely for language polishing and paraphrasing. These AI tools were only applied to refine the authors’ original ideas and were not used to generate any scientific arguments, interpretations, or data.

Institutional review board statement: The study received approval from the Ethics Committee of Ankara Bilkent City Hospital (Approval No. TABED 1-24-373) and was conducted in accordance with the principles set out in the Declaration of Helsinki.

Informed consent statement: All participants have signed the relevant informed consent forms.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author. This approach was reviewed and approved by the institutional ethics committee.

Corresponding author: Ilhami Yuksel, MD, Professor, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, İhsan Doğramacı Caddesi, Bilkent, Ankara 06800, Türkiye. yukselilhami@hotmail.com

Received: March 5, 2026
Revised: March 23, 2026
Accepted: May 19, 2026
Published online: November 21, 2026
Processing time: 204 Days and 7.7 Hours

Abstract

BACKGROUND

Treatment of inflammatory bowel diseases (IBDs) is challenging due to the maintenance of remission and associated fetal safety concerns during pregnancy. While existing literature emphasizes the importance of achieving remission prior to conception, optimal management of IBD during pregnancy remains underexplored, especially regarding medication continuation and efficacy.

AIM

To evaluate the effect of treatment discontinuation on disease activation and pregnancy outcomes in a cohort of patients with IBD.

METHODS

This observational study was performed with pregnant patients with IBD between March 2019 and June 2023. Clinical features, treatment details, disease activation and outcomes were collected and analyzed.

RESULTS

A total of 57 pregnant woman was included, of whom 37 (64.9%) had ulcerative colitis (UC) while 20 (35.1%) had Crohn’s disease (CD). Before pregnancy, medical treatments for UC patients included mesalazine in 29 (78.4%) patients, thiopurine in 20 (54.1%) and biologic therapy in 6 (16.2%). Among the CD patients, 13 (65%) received biologic therapy and 7 (35%) received thiopurine. The most commonly prescribed biologic agent was infliximab for both diseases. During pregnancy, 16 (28.1%) patients, including 6 (18.8%) with UC and 10 (50%) with CD, had a history of treatment discontinuation. Thirteen (81%) medications were discontinued in line with the patient’s preference, with the vast majority of these discontinuations occurring immediately after confirmation of pregnancy rather than during the preconception planning phase. Notably, the majority of cases of patients discontinuing their treatment independently occurred prior to any structured medical counseling regarding the safety of IBD medications during pregnancy. Disease activation occurred for 25 (43.9%) patients, including 10 (50%) with CD and 15 (40.5%) with UC. Twelve (48%) patients required steroids due to activation. There were 54 (94.7%) live births and no statistically significant difference in the live birth rate according to whether disease activation developed or not [23 (92%) vs 31 (96.9%), P = 0.576]. The abortion rate was not associated with disease activation (P > 0.05). No serious infections occurred in the first month following birth.

CONCLUSION

The discontinuation of medical treatment during pregnancy at the patient’s discretion was significantly correlated with disease exacerbations, particularly in patients with UC, and subsequent salvage steroid treatment. These findings underscore the vital role of patient counseling prior to and during pregnancy, with the objective of ensuring medication compliance and optimizing maternal and fetal outcomes.

Keywords: Pregnancy; Inflammatory bowel diseases; Ulcerative colitis; Medication adherence; Disease exacerbation; Crohn’s disease

Core Tip: This study indicates that treatment discontinuation during pregnancy constitutes a substantial and preventable cause of disease exacerbation in women diagnosed with inflammatory bowel diseases, particularly ulcerative colitis. The related increase in the need for salvage steroid therapy reflects the critical importance of pre-pregnancy counseling to ensure treatment compliance and improve maternal and fetal outcomes.