Management of Pregnant Women with Inflammatory Bowel Disease and COVID-19-Balancing Risks of Delayed Treatment Recommencement.

We read with interest the recently published manuscript by De Lima-Karagiannis et al ., ‘Management of pregnant inflammatory bowel disease [IBD] patients during the COVID-19 pandemic’. 1 We commend the authors for their clear recommendations. In the setting of COVID-19 infection, irrespective of severity, De Lima-Karagiannis et al. recommend withdrawal of all IBD medications barring 5-aminosalicylates [5-ASAs], with recommencement following two negative SARS-CoV-2 PCRs. 1 We suggest that a nu-anced, patient-specific approach may be more appropriate. We have recently managed a G1P0 partially vaccinated 25 year-old pregnant female with A2B1L1 Crohn’s disease and COVID-19 infection at 18 weeks of gestation. She had mild sonographic IBD activity in first trimester, and was receiving standard-dose adalimumab monotherapy. Her COVID-19 infection was managed in the community, without requirement for supplemental oxygen or COVID-19 specific medical therapies. Her adalimumab was briefly withheld and recommenced following COVID-19 clearance, as defined clinically and with negative RT-PCR at