{
  "abstract": "Introduction Active inflammatory bowel disease in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes. Understanding predictors and patterns of disease may inform strategies for optimising care.Methods A retrospective cohort study was conducted of pregnancies managed through an IBD - antenatal clinic between August 2020 and July 2025. Patients were stratified according to disease activity during pregnancy. Active disease was defined by symptoms and inflammatory biomarkers (CRP and/or FCP), informing Physician Global Assessment. Univariate logistic regression was performed to identify predictors of active disease during pregnancy, represented as an odd’s ratio (OR).Results A total of 246 completed singleton pregnancies were included:128(52.0%) Crohn’s, 105 (42.7%) Ulcerative Colitis and 13 (5.9%) IBD-U.Women with active disease at pre-conception had a significantly higher probability of active disease during pregnancy (OR 13.1, 95% CI 6.1–28.2, p<0.001). Changes in disease state across pre-conception, conception, the pregnancy and the post-partum period are highlighted in figure 1.Those with active disease in pregnancy had a higher rate of fetal growth restriction (5.1% vs 0.0%, p=0.030) and low birth weight (16.2% vs 4.9%, p=0.020), and numerical but non-significant higher rates of small for gestation babies (10.3% vs 6.7%, p=0.401) and emergency c-sections (28.0% vs 15.7%, p=0.056).Factors associated with a reduced risk of active disease at pregnancy included peri-anal disease (OR 0.38; 95% CI 0.15-0.97, p= 0.043) and biologic use at conception (OR 0.47; 95% CI 0.26-0.86, p=0.001).Increased risk of active disease was associated with women who were underweight (BMI <18.5) (OR 16.6; 95% CI 2.08-132.80, p=0.008), of Asian ethnicity (OR 2.44; 95% CI 1.37-4.31, p=0.002), had a diagnosis of UC (OR 2.47; 95% CI 1.41-4.33, p=0.002) or IBD-U (OR 3.46; 95% CI 1.03-11.66, p=0.046), a disease duration of less than 1 year at time of pregnancy (OR 7.92; 95% CI 1.42-44.03, p=0.018) and colonic CD (OR 16.11; 95% CI 2.07 – 125.47, p=0.008).Conclusion Disease activity in the pre-conception period is the strongest predictor of disease activity during pregnancy. Pre-conception counselling represents a critical opportunity to optimise disease control or counsel the patient on the deferral of conception until remission is achieved. Proactive, multidisciplinary care throughout pregnancy remains essential to promptly identify and treat disease flares, particularly in higher-risk groups.Abstract P192 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Krishna Shah"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom",
        "Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "Gareth Parkes"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Mandeep Kaler"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom",
        "Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "James Lindsay"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom",
        "Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "Klaartje Kok"
    }
  ],
  "title": "P192 Predictors and patterns of disease activity in pregnant women with inflammatory bowel disease",
  "uid": "57e3f11c-9f62-5136-868e-c798c34d3a3e"
}