Women diagnosed with Crohn’s disease during childhood or adolescence did not face a higher risk of preterm delivery or adverse neonatal outcomes than women diagnosed in adulthood, according to a retrospective study of 262 births. In some measures of fetal growth, outcomes favored the pediatric-onset group: Infants born to mothers with pediatric-onset Crohn’s disease were less likely to be small for gestational age and had higher birth-weight percentiles.
Disease activity during pregnancy, rather than age at diagnosis, emerged as a stronger predictor of neonatal outcomes.
“Despite the pregnancy literature, a key question remains unanswered: How do pregnancy and neonatal outcomes compare in women diagnosed with Crohn’s disease in childhood versus adulthood?” said senior author Jacob A. Kurowski, MD, of Cleveland Clinic’s Division of Pediatric Gastroenterology, Hepatology and Nutrition in an interview with GI & Hepatology News. “Our study set out to answer that question, and the results were reassuring. With much greater certainty, I can now tell young women and their parents that based on our findings, they can expect similar, if not better, outcomes for both themselves and their children.”
The study, published in Gastro Hep Advances, evaluated pregnancy and neonatal outcomes among women with Crohn’s disease who delivered at Cleveland Clinic between 2012 and 2023. Researchers sought to determine whether pediatric-onset disease, which is often associated with greater disease burden and longer cumulative disease duration, affected gestational age at delivery or neonatal birth weight.
The investigators reviewed 262 births among 179 women with Crohn’s disease. Of those births, 105 (40%) were to women diagnosed before age 18, and 157 (60%) were to women diagnosed as adults. The team manually reviewed electronic medical records to collect information on patient characteristics, disease history, medications, pregnancy outcomes and newborn health. The study’s two main outcomes were gestational age at delivery and birth-weight percentile.
Overall, neonatal outcomes were favorable. Nearly 9 in 10 infants were born at term, with a median gestational age of 39.1 weeks. The median birth-weight percentile was 50, and just 11% of infants were considered small for gestational age.
The clearest difference between the groups involved fetal growth. Only 4% of infants born to mothers with pediatric-onset Crohn’s disease were small for gestational age, compared with 16% of those born to mothers with adult-onset disease. Infants in the pediatric-onset group also had a higher median birth-weight percentile (64 vs. 43). Gestational age at delivery was similar between the groups.
After the researchers accounted for maternal age and other clinical factors, pediatric-onset Crohn’s disease was associated with a 16-point increase in birth-weight percentile compared with adult-onset disease. However, age at diagnosis was not associated with differences in gestational age at delivery.
Disease duration also appeared to influence outcomes. For every 10% increase in the proportion of a woman’s life spent living with Crohn’s disease, the likelihood of delivering a small-for-gestational-age infant decreased by 21%. That association remained largely unchanged after researchers accounted for factors such as biologic therapy, disease type, perianal disease and mode of delivery.
Disease activity during pregnancy was linked to poorer fetal growth. Women who experienced a Crohn’s disease flare requiring corticosteroid treatment or a change in therapy during pregnancy had infants with birth-weight percentiles about 11 points lower than those of women without a flare. Although flares were not associated with gestational age at delivery, the findings support previous research showing that active inflammatory bowel disease (IBD) during pregnancy can adversely affect fetal growth.
Medication use at conception was also associated with neonatal outcomes. Women receiving anti–tumor necrosis factor therapy when they became pregnant had infants with birth-weight percentiles nearly 9 points higher than those of women not receiving biologic therapy. Anti-TNF treatment was also associated with delivery about 0.8 weeks later. The authors noted that women with pediatric-onset Crohn’s disease were more likely to be receiving biologic therapy at conception, which may have helped keep disease activity under control during pregnancy.
Pregnancy outcomes were largely similar between the two groups. Rates of disease flare during pregnancy or after delivery, preterm premature rupture of membranes and intrauterine growth restriction did not differ significantly. However, cesarean delivery was more common among women with pediatric-onset Crohn’s disease, occurring in 61% of deliveries compared with 48% among women with adult-onset disease. The researchers suggested that the higher rate of perianal disease among women with pediatric-onset Crohn’s disease may help explain the difference.
“I now feel much more confident counseling young women with Crohn's disease about future pregnancy and neonatal outcomes,” Dr. Kurowski concluded. “Our findings also provide additional support for the use of early biologic therapy to optimize disease control. Consistent with prior studies, we again confirmed that active disease has a significant negative impact on neonatal outcomes, reinforcing the importance of achieving and maintaining remission before and during pregnancy.”
The authors acknowledged several limitations, including the study’s retrospective design and incomplete data on disease activity, inflammatory markers and endoscopic findings. They also noted that miscarriages and spontaneous abortions were likely underreported, as many occurred outside the health system and were therefore not captured in the medical record.
The study received funding support from The Garber Family Foundation and Athletes vs Crohn’s & Colitis. Dr. Kurowski and coauthors reported no relevant conflicts.
Expert Insight
GI & Hepatology News invited Sudheer Kumar Vuyyuru, MBBS, MD, DM, an inflammatory bowel disease specialist at Western University, London, Ontario, Canada, to comment on the work.
What makes this study important?
Dr. Vuyyuru: Approximately one fourth of all Crohn’s disease (CD) cases are diagnosed during childhood or adolescence. As many of these individuals reach reproductive age, understanding the impact of pediatric-onset CD on pregnancy outcomes is increasingly important. This study provides timely and meaningful insights for gastroenterologists managing this growing patient population.
How might the findings influence clinical practice?
Dr. Vuyyuru: The findings are both reassuring and clinically informative. Contrary to expectations, neonates born to mothers with pediatric-onset CD experienced significantly better outcomes than those born to mothers with adult-onset CD, including lower rates of small-for-gestational-age (SGA) infants (3.8% vs. 15.9%, P= 0.02) and higher birth weight percentiles (a mean of 16.2 percentage points). Importantly, disease activity but not age at CD onset emerged as the primary determinant of pregnancy outcomes. Pregnancy flares were associated with a 10.8%-point reduction in birth weight percentile, whereas anti-TNF therapy at conception was associated with an 8.7%-point increase. These findings provide evidence-based reassurance that women with pediatric-onset CD can expect favorable pregnancy outcomes when their disease is well controlled. They further underscore the importance of achieving and maintaining sustained remission before conception and throughout pregnancy as a central component of preconception counseling and disease management.
What questions remain unanswered?
Dr. Vuyyuru: Despite its important contributions, several limitations warrant consideration. The retrospective, single-center design and predominantly Caucasian study population may limit the generalizability of the findings. In addition, disease activity was inconsistently documented in the electronic medical record, resulting in a less rigorous definition of remission. The study also focused exclusively on CD, leaving the impact of pediatric-onset ulcerative colitis on pregnancy outcomes unanswered. Furthermore, with only 105 births among women with pediatric-onset CD, the study was underpowered to detect differences in uncommon outcomes such as preeclampsia and congenital malformations. Future prospective, multicenter studies incorporating validated measures of disease activity, population-based controls, more diverse patient populations, and patient-reported outcomes are needed to confirm these findings and address the remaining evidence gaps.
Do you have any final thoughts on this work?
Dr. Vuyyuru: The observation that longer disease duration was associated with a lower risk of SGA infants is intriguing and may reflect improved disease control and treatment optimization over time. While hypothesis-generating, these findings merit further evaluation in prospective studies. Importantly, the study underscores the need for early reproductive counseling in girls diagnosed with pediatric-onset CD, well before they reach childbearing age. Such counseling should address the importance of sustained disease control, the safety of IBD therapies during pregnancy, and the potential fertility implications of prior pelvic surgery. Future research should capitalize on prospective pregnancy registries, such as PIANO and Canadian IBD research networks, incorporating validated disease activity measures and patient-reported outcomes to strengthen the evidence base and better inform pregnancy planning and management in this growing population.
Dr. Vuyyuru reported receiving consulting fees from Alimentiv Inc.