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

In IBD patients who are pregnant or planning pregnancy, the goal remains stable steroid-free remission before conception, throughout pregnancy, and postpartum, because active disease (not medication) is the dominant driver of adverse maternal/fetal outcomes (preterm birth, growth restriction, low birth weight, hypertensive disease, cesarean birth). Continue effective maintenance therapy on schedule through pregnancy and lactation, mesalamine, thiopurines, and biologics/biosimilars (anti-TNF, vedolizumab, ustekinumab), rather than stopping for pregnancy; discontinuation raises postpartum flare and complication risk. SCOPE OF THE CITED SOURCE, read this before extending the sentence above: the IL-23p19 antagonists are NOT addressed by the 2019 AGA IBD Parenthood Project pathway, which predates their IBD indications entirely (Drugs@FDA efficacy-supplement approvals: risankizumab for Crohn's disease June 2022 and for ulcerative colitis June 2024; mirikizumab for ulcerative colitis October 2023 and for Crohn's disease January 2025; guselkumab for ulcerative colitis September 2024 and for Crohn's disease March 2025). Continuing risankizumab, guselkumab or mirikizumab through pregnancy and lactation is EXPERT PRACTICE extrapolated from the other monoclonal antibodies, it is not a recommendation of the cited document, and it must not be presented as one. All three FDA labels state that the available human pregnancy data are insufficient to establish a drug-associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes, and all three carry a pregnancy exposure registry: enrol the patient and document the shared decision. Avoid JAK inhibitors during pregnancy and lactation due to insufficient reproductive safety data. For suspected flare, favor fecal calprotectin plus intestinal ultrasound or non-gadolinium MRI over CT, reserve endoscopy for when it will change management, and use corticosteroids or biologic initiation/switching as clinically necessary. Recommend cesarean delivery for active perianal Crohn's disease and now also consider cesarean for patients with a prior ileal pouch-anal anastomosis (IPAA) to protect pouch function. New elements versus prior guidance: low-dose aspirin started at 12-16 weeks gestation to reduce preeclampsia risk, structured VTE risk monitoring pre-delivery and postpartum, and explicit endorsement of breastfeeding while on biologic therapy. Multidisciplinary GI/MFM coordination is maintained throughout.