[KASID Guidelines for Sexuality, Fertility, Pregnancy, and Lactation in Inflammatory Bowel Disease: 2026]

Inflammatory bowel disease (IBD) is commonly diagnosed during the reproductive years, making sexuality, fertility, pregnancy, and lactation central to long-term care. Misconceptions about heritability, fertility, and medication safety contribute to voluntary childlessness and discontinuation of effective therapy during pregnancy. Accumulating evidence indicates that disease activity, rather than IBD itself or most maintenance therapies, is the major determinant of adverse maternal and fetal outcomes, supporting a paradigm centered on remission before and throughout pregnancy. Meanwhile, newer biologics and small molecules have been incorporated into clinical practice despite limited human reproductive safety data. Uncertainties persist regarding drug continuation, disease monitoring, mode of delivery, breastfeeding, and live vaccination in infants exposed to biologics in utero, highlighting the need for guidance tailored to the Korean national immunization program. The Korean Association for the Study of Intestinal Diseases therefore developed the first guideline in Korea addressing sexuality, fertility, pregnancy, and lactation in patients with IBD. Recent international guidance informed the scope and key questions; however, all evidence was independently reviewed and synthesized, and all recommendations were developed de novo using the GRADE methodology. Given limited randomized trial evidence in pregnancy, evidence synthesis relied primarily on systematic reviews, pregnancy registries, and large cohort studies. Consequently, the certainty of evidence for all recommendations was low or very low. All statements underwent a modified Delphi consensus process. The final guideline comprises 40 statements across 11 chapters: 23 recommendation statements, 9 evidence statements, and 8 expert consensus statements. This guideline supports individualized care throughout the reproductive continuum.