Disease Control, Not Age at Diagnosis, Drives Pregnancy Outcomes in Crohn’s Disease

Neonatal outcomes in women with Crohn’s disease (CD) appear to be more strongly influenced by disease control than by age at diagnosis, according to a retrospective study evaluating pregnancy outcomes in pediatric- versus adult-onset CD.

The study included 262 births from 179 women with CD between 2012 and 2023, with 40.1% of pregnancies occurring in women diagnosed before age 18. Gestational age at delivery did not differ between groups, suggesting comparable rates of preterm birth regardless of disease onset.

Differences emerged in birthweight outcomes. Neonates born to women with adult-onset CD had a higher rate of small-for-gestational-age (SGA) status compared with those born to women with pediatric-onset disease (15.9% vs 3.8%). Longer disease duration appeared protective, with the odds of SGA decreasing as the proportion of life lived with CD increased.

Disease activity during pregnancy had a measurable impact. A CD flare was associated with a reduction in birthweight percentile at delivery, reinforcing the importance of disease control. In contrast, anti–tumor necrosis factor (TNF) therapy at conception was associated with improved birthweight percentiles.

The authors reported that “neonates born to women with pediatric-onset CD have excellent outcomes,” and concluded that “disease control has a more significant impact on neonatal outcomes than age of onset or disease duration.”

These findings support proactive disease management and continued use of effective therapies during pregnancy, emphasizing that maternal disease activity—not disease duration or age at diagnosis—is the primary determinant of neonatal outcomes in CD.

ReferenceSwamy S, Achkar, JP, Ehrenberg S, et al. Neonatal and pregnancy outcomes in pregnant adults with pediatric-onset Crohn’s disease. Gastro Hep Adv. Articles in press, April 2026. DOI: 10.1016/j.gastha.2026.100959