Abstract Background Outcomes of colorectal surgery for inflammatory bowel disease (IBD) during pregnancy are not well defined in the literature, due to its rarity. We aimed to review the literature on maternal and fetal outcomes after colorectal surgery for medically refractory IBD during pregnancy. We hypothesized worse outcomes in Crohn’s disease (CD) compared to ulcerative colitis (UC). Methods A search of Medline, PubMed, Embase and Cochrane Library databases was performed to identify studies from 1969 – 2023 regarding surgery during pregnancy for medically refractory IBD. Meta-analyses on maternal and fetal morbidity were conducted using a generalized linear mixed model (GLMM) for overall estimates, followed by descriptive estimates by IBD subgroup (UC vs CD). Studies that did not describe morbidity by IBD subgroup were included in overall morbidity estimates but excluded in subgroup estimates. Results Forty studies with a total of 122 patients were reviewed. The pooled median age was 27 (IQR, 22-30) years old. Patients most commonly (54.9%) required operative intervention in their 2nd trimester, while 23.8% and 21.3% were in their 1st and 3rd trimester, respectively. More patients had CD (59%) than UC (39.3%). Most common operations were colectomy/subtotal colectomy (29.6%), small bowel resection (26.2%) and ileocolic resection (18.9%). Diversion was performed in 54.1% of cases. Summed maternal morbidity rate was 31.1% (37/119 reported patients). Delivery was at term in 76.5% and early but without morbidity in 5% (6/119); summed fetal morbidity was 21.8%. On meta-analysis (Table 1), maternal postoperative morbidity had a pooled estimate of 24.4% (95% CI 12.2-42.8%; prediction interval 4-71.2%). Pooled overall estimate of fetal morbidity (Figure 1) was 22.6% (95% CI 11.7-39%; prediction interval 2.3-78.4%). Sum maternal postoperative morbidity was 47.4% (18/38) in CD versus 16.2% (6/37) in UC patients; sum fetal morbidity was 28.9% (11/28) in CD versus 24.3% (9/37) in UC patients. Given a significant volume of case reports (32/40 studies, 80%) and only abstract availability for several studies (9/40, 22.5%), meta-regression results were used only for comparison to overall estimates. Conclusion In this first meta-analysis of colorectal surgery for IBD during pregnancy, 1:4 mothers and 1:5 fetuses experienced postoperative complications, although most pregnancies progressed to term. When surgery is indicated, it should not be deferred but should be undertaken in a multidisciplinary manner. Crohn’s patients may be at higher risk for maternal and fetal morbidity than ulcerative colitis patients, although numbers were small and heterogeneity substantial. These data may be used to counsel expectant parents regarding anticipated outcomes. Conflict of interest: Dr. Unal, Ece: No conflict of interest Silva, Nicholas: No conflict of interest Kc, Devesh: No conflict of interest Pierce, LaDonna: No conflict of interest Tang, Li: No conflict of interest Holubar, Stefan: Grant: Surgical Research Network Grant American Society of Colon & Rectal Surgeons Grant Personal Fees: Shionogi, Takeda, Guidepoint
Unal et al. (2026) studied this question.