S1538 Racial Disparities in Pregnancy Outcomes Among Women With Inflammatory Bowel Disease

Introduction: Women with inflammatory bowel disease (IBD) are at increased risk for adverse pregnancy outcomes. Minority populations also face worse general obstetric outcomes. We aimed to compare risks of adverse pregnancy outcomes between racial cohorts with IBD. Methods: We conducted a retrospective cohort study across 147 healthcare organizations using the TriNetX database. Women aged 15–45 years from 2010–2024 who were diagnosed with pregnancy, and Crohn’s disease or ulcerative colitis were included. Exclusions were pregestational diabetes, systemic lupus erythematosus, and multiple gestations. Patients were divided into White and Hispanic cohorts. Propensity score matching (1:1) was performed for age, BMI, primary hypertension, smoking, maternal comorbidities, and surgical history. Outcomes within 9 months of pregnancy included premature rupture of membranes (PROM), gestational hypertension, biologic use, and IBD complications (ulcers, abscesses, or fistulas). Patients with prior IBD complications were excluded. Risk was reported as risk ratios (RR) with 95% confidence intervals (CIs). Results: After matching, 2,204 women were included, with a mean age of 30.45 years. Hispanic women had a significantly higher risk for PROM compared to White women (RR 1.850, CI 1.081–3.167), and a lower risk of gestational hypertension (RR 0.679, CI 0.484–0.953). They were also less likely to receive biologic therapy (RR 0.766, CI 0.618–0.950). Rates of IBD complications were higher among Hispanic women, though not statistically significant (RR 1.213, CI 0.665–2.213). Conclusion: Hispanic women with IBD face increased risk of PROM and lower risk of gestational hypertension, highlighting the complexity of pregnancy outcomes across racial groups. These differences may reflect true physiological variation, underdiagnosis, or variations in care-seeking behaviors. Biologic use was significantly lower among Hispanic women, suggesting potential barriers to treatment access. Although IBD complications were not significantly different, higher observed rates in Hispanic women warrant further study. These findings underscore the need for equitable, individualized IBD care during pregnancy and call for research into systemic factors contributing to these disparities.