Higher rates of active disease and adverse pregnancy outcomes in minority ethnic groups with Inflammatory Bowel Disease
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Authors
Shah K.
Kaler M.K.
Parkes G.
Lindsay J.O.
Kok K.
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Issue Date
2026
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Background: Active inflammatory bowel disease (IBD) during pregnancy is associated with an increased risk of adverse outcomes. Disparities in healthcare access and outcomes across ethnic groups remain under-explored in IBD pregnancy care. The aim of this study was to understand if ethnicity had an impact on disease activity and pregnancy outcomes. Method(s): A retrospective cohort study included all pregnancies managed via a tertiary hospital joint IBD-Antenatal Clinic between August 2020 and January 2025. Patients were categorised into: (i) White Ethnic Background (WEB: White British, Irish, and European) (ii) Minority Ethnic Background (MEB: Bangladeshi, Pakistani, Sri Lankan, Indian, Black, Mixed, and "other" background) Disease activity was defined using symptoms and clinical biomarkers (CRP/ FCP) to inform a Physician Global Assessment. Patients were stratified as having "Active disease" or being in "Remission". Result(s): A total of 207 patients were included (WEB = 106; MEB = 101). MEB patients had a lower mean (+/-SD) maternal age (31.7 (+/-4.7) vs 34.0 (+/-4.5) years, p < 0.001) and shorter median (IQR) disease duration (7 (3-11) years; vs 10(5-15) years, p = 0.001). MEB women were less likely to be nulliparous (36.6% vs 52.0%, p = 0.021) and more likely to have had 3 or more previous pregnancies (21.8% vs 10.8%, p = 0.021). Baseline characteristics such as BMI, smoking status, alcohol use, diagnosis, disease phenotype, previous bowel resection and biologic exposure were comparable. Compared to pre-conception (MEB 29.3% vs WEB 18.9%, p = 0.080), rates of active disease increased in both groups during pregnancy but was significantly higher in MEB patients (51.5% vs 28.2%, p < 0.001). Adverse outcomes including gestational diabetes (17.8% vs 6.1%, p = 0.031), emergency c-sections (20.8% vs 10.4%, p = 0.038), pre-Term birth (11.9% vs 1.9%, p = 0.033), low birth weight (11.9% vs 3.8%, p = 0.029) and NICU admission (11.8% vs 1.8%, p = 0.033) were higher in the MEB patients. Rates of small-for-gestational age (9.0% vs 8.3%, p = 0.889), foetal growth restriction (2.2% vs 3.3%, p = 0.230) and birth defects (1.2% vs 0.0%, p = 0.421) were comparable between the two populations. Conclusion(s): This study highlights a disproportionate burden of active disease and adverse pregnancy outcomes among patients from minority ethnic backgrounds with IBD. Disparities persist despite equivalent access to a joint IBD-Antenatal clinic, suggesting that additional socioeconomic, cultural, or systemic barriers may contribute. A targeted approach addressing disparities through pre-conception counselling, earlier engagement with services, tight disease control and tailored multidisciplinary support is essential to improving equity in IBD pregnancy care.
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Journal of Crohn's and Colitis
Volume
20