Clinical utility of blood-based biomarkers in pregnant women with inflammatory bowel disease.

INTRODUCTION

Pregnancy in women with inflammatory bowel disease (IBD) is common, and active disease remains a key driver of adverse maternal and fetal outcomes. Maintaining remission throughout pregnancy is therefore essential, however clinicians lack reliable, minimally invasive tools to monitor disease activity and stratify pregnancy-related risk.

AREAS COVERED: This expert review critically addresses the current evidence on blood-based biomarkers for pregnancy in women with IBD. We discuss the impact of maternal disease activity on pregnancy outcomes, the bidirectional relationship between pregnancy and IBD disease course, and the potential contribution of placental dysfunction and oxidative stress to adverse outcomes. Established and emerging biomarkers, including fecal calprotectin, inflammatory, angiogenesis-, and oxidative stress-related biomarkers, are evaluated. We further outline methodological challenges, limitations of single biomarkers, and unmet needs in validation and clinical translation.

EXPERT OPINION: We emphasize that the persistent focus on isolated biomarkers is unlikely to meet the complexity of pregnancy in patients with IBD. Instead, we propose that integrative multi-omics approaches capturing interacting biological processes represent a more conceptually sensible path forward. While rigorous prospective validation and standardization are essential before clinical implementation, such strategies hold promise for more personalized risk stratification and monitoring of pregnant patients with IBD.