Abstract 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. Methods 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”. Results 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 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. Conflict of interest: Dr. Shah, Krishna: No conflict of interest Kaler, Mandeep K: No conflict of interest Parkes, Gareth: Dr Gareth Parkes reports personal payments, honoraria, speaker fees, travel grants and/or fellowships from AbbVie, Allergan, Bristol Myers Squibb, Celltrion, Ferring, Galapagos, Janssen, Napp, Takeda, and Tillotts, and directorship and shareholding with Ampersand Health. Dr. Parkes reports personal grants from AbbVie personal consulting fees from AbbVie, Arena, Aslan, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Ferring, Galapagos, Gilead, GlaxoSmithKline, Heptares, LabGenius, Janssen, Monte Rosa, MSD, Mylan, Novartis, Numab, Pfizer, Roche, Sandoz, Takeda, UCB, and XAP membership of the ECCO Scientific Committee, and membership in the UEG Scientific Committee director of Endoread. Lindsay, James O: No conflict of interest Kok, Klaartje: Speaker or advisory fees or support for attending conferences from Abbvie, Janssen, Takeda, Galapagos, Lilly, Falk.
Shah et al. (Thu,) studied this question.