Impact of IBD Medications During Pregnancy on Maternal and Child Health: A Systematic Review and Meta-Analysis

Backgrounds: Inflammatory bowel disease (IBD) impacts pregnant women, raising concerns about medication safety. This systematic review and meta-analysis aimed to assess the association of IBD medications with pregnancy and neonatal outcomes. Methods: We systematically searched major databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library) from inception to June ۹, ۲۰۲۵. Eligible cross-sectional, case-control, and cohort studies comparing pregnant IBD patients receiving IBD-related drugs with unexposed controls were included. Subgroup analyses were conducted based on drug categories (biologics, immunomodulators, corticosteroids, ۵-aminosalicylic acid (۵-ASA), and a combination of biologics and immunomodulators). Results: Thirty-three studies were included. Biologics showed higher risk of spontaneous abortion (OR = ۱.۵۹, ۹۵% CI [۱.۰۷, ۲.۳۶]), preterm birth (OR = ۱.۲۳, [۱.۰۳, ۱.۴۸]), hypertension (OR = ۱.۹۱, [۱.۱۵, ۳.۱۷]), LBW (OR = ۱.۳۲, [۱.۰۱, ۱.۷۴]), while reducing GD risk (OR = ۰.۷۹, [۰.۶۷,۰.۹۴]). Immunomodulators were linked to increased stillbirth (OR ۱.۸۴, [۱.۲۶, ۲.۶۹]), while having a protective effect against GD (۰.۸۵, [۰.۷۴,۰.۹۹]). Combination therapy increased the risk of preterm birth (OR = ۱.۴۶, [۱.۱۱, ۱.۹۱]) and CMS (OR = ۱.۵۷, [۱.۰۱, ۲.۴۳]). Corticosteroids resulted in an increased risk of preterm birth (۱.۷۶, [۱.۳۰, ۲.۳۷]) and LBW (OR=۱.۹۳, [۱.۳۳, ۲.۸۱]), while reducing the risk of CMS (OR = ۰.۶۲, [۰.۴۲, ۰.۸۰]). ۵-ASA showed an increased risk of stillbirth (OR = ۵.۲۶, [۲.۲۹, ۱۲.۰۵]). Overall, these five medication groups contributed to an increased risk of preterm birth (OR = ۱.۲۹, [۱.۱۵, ۱.۴۵]). No significant relationship was found between these medications and SGA, low Apgar score, newborn antibiotic use, infections, NICU admission, and hospitalization.No significant relationship was found with small for gestational age (SGA), low Apgar score, newborn infections, antibiotic use, NICU admission, and hospitalization. Conclusion: IBD medications in pregnancy are associated with varied perinatal outcomes depending on drug class. These findings highlight the importance of personalized treatments, considering both disease control and pregnancy and fetal safety.