Reproductive Health in Inflammatory Bowel Disease: From Fertility to Maternal–Fetal Outcomes — Determinants, Preconceptional Considerations, and Therapeutic Exposure

Abstract

Inflammatory bowel disease (IBD) — chiefly Crohn's disease (CD) and ulcerative colitis (UC) — frequently affects women of reproductive age. Disease activity, treatment, surgery, and nutritional status may all influence fertility, family planning, preconception preparation, and maternal–fetal outcomes. Data from North Africa remain limited. The study objective was to evaluate the reproductive health of women with IBD and to identify determinants of impaired conception and adverse pregnancy outcomes, with particular attention to the role of disease activity at conception. Observational, ambispective, multicentre, longitudinal cohort study including 460 women aged 18–45 years with CD or UC, followed at Sétif and El Eulma. Sociodemographic, clinical, surgical, nutritional, biological, therapeutic, and reproductive data were collected. Factors associated with infertility and adverse obstetric outcomes were assessed by multivariable logistic regression. Mean age was 31.5 ± 5.2 years; 223 women (48.5%) had CD and 237 (51.5%) had UC. A pregnancy project was reported by 289 women (62.8%), of whom 218 (75.4%) conceived. In total, 275 pregnancies were analysed; active disease was present at conception in 49 cases (17.8%). A composite adverse outcome occurred in 63 pregnancies (22.9%). IBD activity at conception was significantly associated with an increased risk of adverse outcome (adjusted OR 3.41; 95% CI 1.71–6.80; p<0.001). The exploratory model had an AUC of 0.67 (bootstrap 95% CI 0.59–0.76). IBD activity at the time of conception is the principal modifiable determinant of adverse pregnancy outcomes. These findings support a structured preconception strategy targeting disease remission, nutritional and therapeutic optimisation, and coordinated gastroenterology–obstetric care.