Impact of IBD medications during pregnancy on maternal and child health: a systematic review and meta-analysis

Inflammatory bowel disease (IBD) impacts pregnant women, raising concerns about medication safety. This systematic review and meta-analysis evaluated the association between IBD medications and pregnancy and neonatal outcomes. Major databases were searched up to June 9, 2025, for cross-sectional, case-control, and cohort studies comparing pregnant IBD patients receiving IBD-related drugs with unexposed controls. Subgroup analyses were conducted by drug categories (biologics, immunomodulators, corticosteroids, 5-aminosalicylic acid (5-ASA), and combination of biologics and immunomodulators). Twelve studies were included. Biologic therapy was not associated with low birth weight (LBW) (OR = 0.99, 95% CI 0.66-1.50) or newborn infections (OR = 0.90, 95% CI 0.68-1.19). Immunomodulator therapy showed no significant associations with spontaneous abortion (OR = 1.18, 95% CI 0.63-2.19), LBW (OR = 0.91, 95% CI 0.28-2.98), or newborn infections (OR = 0.84, 95% CI 0.19-3.70). Results for preterm birth and small for gestational age (SGA) demonstrated high heterogeneity and should therefore be interpreted with caution. In addition, the result for congenital malformations was not robust, as it lost statistical significance in the leave-one-out (LOO) sensitivity analysis. Among pregnant patients with IBD, available observational evidence does not demonstrate a consistent association between medication exposure and adverse outcomes including LBW, and spontaneous abortion. Observed associations with preterm birth, and infection should be interpreted with caution given the risk of confounding by indication, heterogeneity across studies, and uncertainty regarding causal effects.