Reflecting on Quality-of-Care Delivery in Inflammatory Bowel Disease Pregnancy: The (Pause and Reflect) PAUSA Study

Abstract Purpose Inflammatory bowel diseases (IBD) have been associated with adverse outcomes during pregnancy, with guidelines developed to inform clinical practice. This study reviewed adherence to guidelines amongst different healthcare providers caring for individuals with IBD during pregnancy. Methods A retrospective multi-centre study of individuals with IBD who received antenatal IBD care at three Australian tertiary units from 2023 to 2025 was undertaken. Clinical documentation for each pregnancy was reviewed against nine process indicators derived from the European Crohn’s and Colitis Guidelines on Sexuality, Fertility, Pregnancy and Lactation [1]. The primary outcome was the proportion of process indicators followed by speciality per pregnancy. Results Forty-three pregnancies amongst 43 individuals were included; 19 (44.2%) had ulcerative colitis. Twenty-six pregnancies (60.5%) were to individuals on biologic therapy for IBD at time of conception. Gastroenterologists met a median 6/9 (67%) process indicators, Obstetrics/Maternofetal Medicine specialists met a median 3/9 (33%) process indicators, and Other Specialists (combined) met a median 1/9 (11%) process indicators per pregnancy. The number of clinic visits and proportion of process indicators followed correlated positively. Adherence to preconception counselling, mental health assessment, and venous thromboembolism risk assessment was particularly poor, completed by Gastroenterology in 39.5, 34.9 and 4.7% of cases, respectively, compared to 4.7, 25.6 and 46.5% of cases by obstetric care providers. Conclusions Uptake of guideline recommendations for antenatal IBD management was variable between different speciality providers in this study of patients with moderate-to-severe IBD. Uptake of recommendations may be improved by increasing access to multidisciplinary care and frequent clinical contact. Whether improvements in adherence with process indicators translates to improved clinical outcomes warrants further evaluation in IBD pregnancy.