Fertility and pregnancy in Inflammatory Bowel Disease

<title>Abstract</title> Inflammatory bowel disease (IBD) is a chronic condition that includes Crohn’s disease (CD) and ulcerative colitis (UC). Both conditions can impact patients' quality of life, particularly during their reproductive years. The influence of IBD on fertility and pregnancy has been widely studied, emphasizing the importance of proper management to minimize maternal-fetal risks and optimize reproductive outcomes. The aim of this review is to understand the impact of IBD on fertility, pregnancy, and perinatal outcomes, as well as to explore recommended management strategies to ensure adequate clinical follow-up in accordance with clinical guidelines and the most up-to-date literature on these topics. Fertility in women with IBD is comparable to that of the general population, although it may be reduced in cases of active disease, a history of abdominal surgery, or psychological factors. IBD activity during pregnancy is associated with increased obstetric complications, making preconception planning and continuous medical monitoring essential. Most IBD treatments are considered safe during pregnancy and breastfeeding, except for certain medications such as methotrexate, JAK inhibitors, and sphingosine-1-phosphate inhibitors. Regarding delivery, cesarean section is recommended only in specific cases, such as active perianal disease or the presence of an ileoanal reservoir. Lastly, breastfeeding is encouraged whenever possible, and vaccination schedules for neonates exposed to immunosuppressants should be adjusted accordingly.