Skip to main content

A national study of pregnancy-related maternal and fetal outcomes in women with inflammatory bowel disease


Background and aims

The incidence of inflammatory bowel disease (IBD) among women is highest during their reproductive years and current estimates suggest that the rate of conception is low in female IBD patients. The aim of our study was to assess the burden of adverse maternal and perinatal outcomes among female IBD patients.


Using the national inpatient sample database from 2016 to 2018, we recruited all female patients above the age of 15 years admitted with a primary diagnosis of pregnancy and a secondary diagnosis of IBD. We adjusted our results for hospital and patient level variables including age, race, socioeconomic status, hypertension, diabetes mellitus, obesity, smoking, hyperlipidemia, alcohol use, and malnutrition. Multivariable regression analysis was used for analysis.


Pregnant women with IBD had greater odds of gestational diabetes (adjusted odds ratio [AOR] 1.55, 95% confidence interval [CI] 1.04–2.3, p 0.02), hypertensive complications (AOR 1.35, 95% CI 1.06–1.72, p 0.01), and pre-term delivery (AOR, 1.41 95% CI 1.13–1.76, p 0.003). Pregnancies with co-existent IBD were associated with fetal growth restriction (AOR 1.27, 95% CI 1–1.63, p 0.04) and fetal death (AOR 3.21, 95% CI 1.72–6.00, p < 0.01). Odds of experiencing postpartum hemorrhage or large for gestational age infant were comparable to general population. Crohn’s disease was independently associated with increased odds of worse maternal and fetal outcome. IBD patients had increased mean length of stay by 0.14 days and increased mean hospital charges of $2741.


Women with IBD had greater likelihood of poor maternal and fetal outcomes and increased hospital resource utilization.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

Study data can be shared on request.

Code availability



  1. Danese S, Sans M, Fiocchi C (2004) Inflammatory bowel disease: the role of environmental factors. Autoimmun Rev 3(5):394–400

    Article  CAS  Google Scholar 

  2. Podolsky DK (2002) Inflammatory bowel disease. N Engl J Med 347(6):417–429

    Article  CAS  Google Scholar 

  3. Lee HH et al (2020) Pregnancy outcomes in women with inflammatory bowel disease: a 10-year nationwide population-based cohort study. Aliment Pharmacol Ther 51(9):861–869

    Article  CAS  Google Scholar 

  4. Mountifield R et al (2009) Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 15(5):720–725

    Article  Google Scholar 

  5. Selinger CP, Ghorayeb J, Madill A (2016) What factors might drive voluntary childlessness (VC) in women with IBD? Does IBD-specific pregnancy-related knowledge matter? J Crohns Colitis 10(10):1151–1158

    Article  Google Scholar 

  6. van der Woude CJ et al (2015) The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 9(2):107–124

    Article  Google Scholar 

  7. Nørgård B et al (2000) Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study. Am J Gastroenterol 95(11):3165–3170

    Article  Google Scholar 

  8. Mahadevan U et al (2007) Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology 133(4):1106–1112

    Article  Google Scholar 

  9. Stephansson O et al (2010) Crohn’s disease is a risk factor for preterm birth. Clin Gastroenterol Hepatol 8(6):509–515

    Article  Google Scholar 

  10. Nielsen OH et al (1983) Pregnancy in ulcerative colitis. Scand J Gastroenterol 18(6):735–742

    Article  CAS  Google Scholar 

  11. Ferguson CB, Mahsud-Dornan S, Patterson RN (2008) Inflammatory bowel disease in pregnancy. Bmj 337(7662):a427

    PubMed  Google Scholar 

  12. Mogadam M et al (1981) The course of inflammatory bowel disease during pregnancy and postpartum. Am J Gastroenterol 75(4):265–269

    CAS  PubMed  Google Scholar 

  13. Fonager K et al (1998) Pregnancy outcome for women with Crohn’s disease: a follow-up study based on linkage between national registries. Am J Gastroenterol 93(12):2426–2430

    Article  CAS  Google Scholar 

  14. Miller JP (1986) Inflammatory bowel disease in pregnancy: a review. J R Soc Med 79(4):221–225

    Article  CAS  Google Scholar 

  15. Nguyen GC et al (2016) The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology 150(3):734-757.e1

    Article  Google Scholar 

  16. Databases H (2019) Healthcare cost and utilization project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD

  17. Sarkar M et al (2020) Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes. J Hepatol 73(3):516–522

    Article  Google Scholar 

  18. Wang CW et al (2022) Outcomes of pregnancy in autoimmune hepatitis: a population-based study. Hepatology 75(1):5–12

    Article  Google Scholar 

  19. Kammerlander H et al (2017) The effect of disease activity on birth outcomes in a nationwide cohort of women with moderate to severe inflammatory bowel disease. Inflamm Bowel Dis 23(6):1011–1018

    Article  Google Scholar 

  20. Baird DD, Narendranathan M, Sandler RS (1990) Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 99(4):987–994

    Article  CAS  Google Scholar 

  21. Mayberry JF, Weterman IT (1986) European survey of fertility and pregnancy in women with Crohn’s disease: a case control study by European collaborative group. Gut 27(7):821–825

    Article  CAS  Google Scholar 

  22. Tandon P et al (2020) Systematic review with meta-analysis: risk of adverse pregnancy-related outcomes in inflammatory bowel disease. Aliment Pharmacol Ther 51(3):320–333

    Article  CAS  Google Scholar 

  23. Leung YP et al (2015) Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with inflammatory bowel disease. J Crohns Colitis 9(3):223–230

    Article  Google Scholar 

  24. Boyd HA et al (2015) Inflammatory bowel disease and risk of adverse pregnancy outcomes. PLoS ONE 10(6):e0129567

    Article  Google Scholar 

  25. Getahun D et al (2014) Association between maternal inflammatory bowel disease and adverse perinatal outcomes. J Perinatol 34(6):435–440

    Article  CAS  Google Scholar 

  26. Ito A et al (2018) Relationship between the clinical course of ulcerative colitis during pregnancy and the outcomes of pregnancy: a retrospective evaluation. Intern Med 57(2):159–164

    Article  Google Scholar 

  27. Cornish J et al (2007) A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut 56(6):830–837

    Article  CAS  Google Scholar 

  28. Bortoli A et al (2011) Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-EpiCom study, 2003–2006. Aliment Pharmacol Ther 34(7):724–734

    Article  CAS  Google Scholar 

  29. Baiocco PJ, Korelitz BI (1984) The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol 6(3):211–216

    CAS  PubMed  Google Scholar 

  30. Oron G et al (2012) Inflammatory bowel disease: risk factors for adverse pregnancy outcome and the impact of maternal weight gain. J Matern Fetal Neonatal Med 25(11):2256–2260

    Article  Google Scholar 

  31. de Lima-Karagiannis A, Zelinkova-Detkova Z, van der Woude CJ (2016) The effects of active IBD during pregnancy in the era of novel IBD therapies. Am J Gastroenterol 111(9):1305–1312

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations



ZT, UF, FK, SS, YG: concept and design of the study, data collection, data analysis, interpretation of results, writing of manuscript and final revision. GG, UZ, FI, AN: interpretation of results and manuscript writing. All authors approved the final version of manuscript.

Corresponding author

Correspondence to Zahid Ijaz Tarar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB at the University of Missouri School of Medicine who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB.

Consent to participate

It is a retrospective study and consent is not required.

Consent for publication

It is a retrospective study and consent is not required.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 KB)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tarar, Z.I., Farooq, U., Zafar, M.U. et al. A national study of pregnancy-related maternal and fetal outcomes in women with inflammatory bowel disease. Int J Colorectal Dis 37, 1535–1543 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: