Dr Uma Mahadevan on the PIANO Global Consensus on Pregnancy in IBD

Dr Uma Mahadevan, the principal investigator for the PIANO registry of IBD in pregnancy, discusses the Global Consensus for this groundbreaking study of the impacts of IBD and medications on fertility, conception, pregnancy, childbirth, breastfeeding, and the health of children born to mothers with ulcerative colitis or Crohn's disease.

Uma Mahadevan, MD, is the Lynne and March Benioff professor of gastroenterology and director of the Center for Colitis and Crohn’s Disease at the University of California San Francisco.

Hello, everybody. My name is Dr. Uma Mahadevan, the Lynn and Mark Benioff Professor of Gastrointrology and Director of the Colitis and Crohn's Disease Center at the University of California San Francisco. I served as the chair of the global consensus on the management of pregnancy and inflammatory bowel disease. And we're gonna go through and give a brief introduction to this process.

IBD is often diagnosed during the reproductive years, making it essential to understand its effects on fertility, pregnancy, and childbirth outcomes. Pregnancy represents a period of intense metabolic, hormonal, microbiome, and immunologic change. So for women with immune-mediated diseases like inflammatory bowel disease, this can increase the risk of pregnancy complications, in part due to the unique role of the placenta and the immune changes that occur during pregnancy. There is limited human data on the safety of new therapies during pregnancy, and for many IBD patients, stopping medication will increase disease activity, leading to change in therapy that was harmful to the patient. Universal guidelines with consistent interpretation of data and sensitivity to regional differences were needed.

So we brought together healthcare professionals and patient advocates from around the globe and we followed GRADE and RAND methodology based on available data. There were 39 global consensus positions and scientists from every continent around the world. These were experts in inflammatory bowel disease, as well as very often experts in pregnancy and fertility. I'm sure you recognize many of the faces here.

We also had multidisciplinary consultants, including Phil Anderson, the founder of Laptman; Susan Fisher, a leading placentologist; Tina Chambers, who is a leading teratologist; Chris Robinson, from maternal fetal medicine; and Emily Finlayson from colorectal surgery. We also had global patient ambassadors from each of the continents who provided their voice and their impressions of the data and our discussions and provided valuable insight into how we should be approaching these decisions.

Dr. Ed Barnes will be giving a separate video talk on grade and on the RAND Consensus panel and how they were used to come up with the guidance for the global consensus statement. We had 10 different subjects: maternal factors impacting pregnancy; fertility; preconception counseling; management of disease activity; management of pregnancy; IBD medications during pregnancy and during lactation; pregnancy adverse events; fetal and neonatal adverse events; and the use of vaccines in the offspring. Each of these 10 categories has a separate video done by the group lead for that section that you can find on this site.

If you go to the pianostudy.org website, you will also find a slide deck in English and Spanish that you as a physician can use for your presentations and video for patients that you can share with your patients that helps them understand the global consensus message and data. And that is in seven languages: English, Spanish, French, Portuguese, Arabic, Arabic, Hindi, and Chinese. You'll also find these subject videos as well as enrollment for the piano registry if you are a US resident.

Thank you and I hope you enjoy the videos.

The full consensus statement from PIANO has been published in

GUT:   https://gut.bmj.com/content/early/2025/08/25/gutjnl-2025-336402

Clinical Gastroenterology and Hepatology:  https://www.cghjournal.org/article/S1542-3565(25)00322-2/fulltext

The American Journal of Gastroenterology:  https://journals.lww.com/ajg/fulltext/9900/global_consensus_statement_on_the_management_of.1899.aspx

Alimentary Pharmacology and Therapeutics:  https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70290

Inflammatory Bowel Diseases:  https://academic.oup.com/ibdjournal/advance-article/doi/10.1093/ibd/izaf171/8241371