Successful pregnancy in a patient with active Crohn's disease, chronic intestinal failure, and long-term parenteral nutrition receiving upadacitinib: A case report.

Data on pregnancy in patients with Crohn's disease receiving Janus kinase (JAK) inhibitors, with concomitant short bowel syndrome and chronic intestinal failure requiring long-term parenteral support, are extremely limited. We report the case of a patient with refractory Crohn's disease, short bowel syndrome-associated chronic intestinal failure, and long-term home parenteral nutrition who achieved a successful full-term pregnancy while receiving upadacitinib. The 34-year-old woman had a history of severe, treatment-resistant ileocolonic Crohn's disease and multiple intestinal resections, leaving 145 cm of small bowel and resulting in high-output stoma and chronic intestinal failure. After inadequate response to multiple biologics, upadacitinib was initiated with clinical and endoscopic improvement. The patient became pregnant unintentionally while receiving upadacitinib 45 mg daily. Through intensive multidisciplinary management, she achieved clinical remission, stable parenteral support needs, and adequate weight gain and delivered a healthy infant at term. This case illustrates that with close multidisciplinary follow-up, successful pregnancy is possible in patients with chronic intestinal failure and active Crohn's disease receiving parenteral support, even with concurrent exposure to upadacitinib. Further data are needed to assess the safety of JAK inhibitors in pregnancy and to guide care in this complex patient population.