Venous thromboembolism prophylaxis in pregnant women with inflammatory bowel disease: evidence gaps and future directions from the KASID Guidelines Task Force Team.

Venous thromboembolism (VTE) is a serious and potentially life-threatening complication in patients with inflammatory bowel disease (IBD), with the risk further increased during pregnancy and the postpartum period. Pregnancy induces a physiological hypercoagulable state, which, when combined with the chronic inflammatory and prothrombotic milieu of IBD, may result in synergistic thrombotic risk. Population-based cohort studies and meta-analyses consistently demonstrate an elevated risk of VTE during pregnancy and the postpartum period among women with IBD compared with those without, with risk being further amplified by active disease, hospitalization, or cesarean delivery. Current gastroenterology and obstetric guidelines recommend selective, risk-stratified thromboprophylaxis rather than routine anticoagulation for all pregnant women with IBD, emphasizing individualized assessment based on disease activity and additional obstetric risk factors. However, the majority of available evidence and current guideline recommendations are based predominantly on data from Western populations. Although the relative risk of VTE appears broadly comparable across ethnicities, Asian populations demonstrate substantially lower absolute incidence rates and distinct obstetric practice patterns, raising concerns regarding the direct applicability of Western guidelines. This narrative review summarizes the current evidence on the risk of VTE associated with pregnancy and the postpartum period in women with IBD and systematically examines existing thromboprophylaxis recommendations and safety considerations. Consequently, it identifies key clinical variables and analytical perspectives relevant to Asian populations that should be addressed in future research and aims to facilitate the development of population-specific, risk-based thromboprophylaxis strategies that balance the benefits and risks of anticoagulation.