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The following is a summary of “Active inflammatory bowel disease on intestinal ultrasound during pregnancy is associated with an increased risk of adverse pregnancy and neonatal outcomes independent of clinical and biochemical disease activity,” published in the March 2025 issue of Gastroenterology by Prentice et al. 

Inflammatory bowel disease (IBD) poses a recognized risk for adverse pregnancy outcomes, particularly when disease activity persists during gestation. Traditional clinical assessment tools, however, may not reliably capture disease activity during pregnancy, raising concerns regarding their utility in guiding obstetric and therapeutic decisions. This international prospective cohort study aimed to evaluate whether intestinal ultrasound, a noninvasive and objective imaging modality, can predict adverse pregnancy outcomes more accurately than standard clinical indices or fecal calprotectin levels. Between 2017 and 2023, 377 pregnant individuals with IBD—198 of whom had Crohn’s disease—were enrolled in three specialized IBD pregnancy clinics. Participants underwent trimester-specific assessments, including clinical disease scores (Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index), FCP testing across all trimesters (T1, T2, T3), and postpartum evaluation at six weeks. IUS was conducted in T1 and/or T2 based on the timing of referral. 

Among 234 participants who underwent IUS, a bowel wall thickness greater than 6 mm in the second trimester was significantly associated with a fourfold increased risk of preterm birth ([RR] 4.01; 95% CI 1.26–12.72; p=0.018) and over twice the risk of delivering a low-birth-weight infant (RR 2.19; 95% CI 1.01–4.72; p=0.046). Furthermore, hyperemia observed on IUS in T2 was linked to a threefold elevated risk of preeclampsia (RR 3.46; 95% CI 1.03–11.12; p=0.046). A stepwise increase in BWT during T2 was independently associated with a higher risk of gestational diabetes, with each 1 mm increment resulting in a statistically significant risk elevation (RR 1.08; p<0.001). Notably, agreement between clinical disease activity indices and objective measures (IUS or FCP) was limited throughout pregnancy, particularly in those with Crohn’s disease, underscoring the limitations of subjective assessment tools during gestation. These findings establish IUS as a valuable adjunct in the antenatal monitoring of IBD, capable of identifying subclinical disease activity that may not be detected through conventional clinical scores or biomarker levels. 

Incorporating IUS into standard prenatal care for patients with IBD may facilitate more timely therapeutic interventions and potentially mitigate the risk of adverse maternal and fetal outcomes. This study highlights the necessity of integrating objective, noninvasive imaging into routine obstetric care for this vulnerable population to improve disease management and pregnancy prognosis.

Source: gastrojournal.org/article/S0016-5085(25)00537-2/abstract