International Survey of Gastroenterologists on Managing Inflammatory Bowel Disease During Pregnancy and Lactation: Current State and the Necessity for Improvements

Background: Reproduction is a fundamental aspect of life. This study aimed to provide an international overview of gastroenterologists' approaches to managing inflammatory bowel disease (IBD) during preconception, pregnancy, lactation, and postpartum. Methods: An anonymous 75-question survey was distributed to gastroenterologists in 36 countries, including European countries, the United States of America, Latin American countries, Australia, and New Zealand, focusing on clinical practices for managing pregnancy and breastfeeding in IBD patients. Results: A total of 856 gastroenterologists participated, 61% were IBD specialists. In pregnant patients in remission, participants stated they would discontinue IBD therapy as follows: 19% for thiopurines, 41% for anti-TNF, 37% for vedolizumab, 31% for ustekinumab, and 96% for small molecules. Many gastroenterologists avoided initiating oral or rectal budesonide, anti-TNF, vedolizumab, or ustekinumab during disease flares. Despite existing safety concerns, one-third of gastroenterologists reported initiating thiopurines to manage disease flares during pregnancy. Only 50% of gastroenterologists had specialized follow-up programs for pregnant patients with IBD in remission. Thirteen percent of gastroenterologists believed that all drugs were safe during breastfeeding. For vaccinations, about 20% advised against non-live vaccines, and 50% avoided live-vaccines during the first 12 months for infants exposed to anti-TNF in utero. Few gastroenterologists had referral pathways to IBD-specialized obstetricians or paediatricians. Conclusion: Our international survey suggests that management of IBD during pregnancy, lactation, and postpartum remains suboptimal, even among gastroenterologists specifically dedicated to IBD. Urgent educational efforts are needed to address these issues and improve care.