Investigators examined the risk of adverse pregnancy outcomes in patients with immune-mediated inflammatory diseases in a report published by Hwang et al in eClinicalMedicine. In a retrospective cohort study, investigators used data from an integrated U.S. community health-care system to analyze the pregnancy outcomes of patients with immune-mediated inflammatory diseases such as psoriasis, inflammatory bowel disease (IBD), rheumatoid arthritis, spondyloarthritis, multiple sclerosis, systemic lupus erythematosus, psoriatic arthritis, antiphospholipid syndrome, Sjögren's syndrome, vasculitides, sarcoidosis, and systemic sclerosis (n = 5,784) and controls (n = 359,291) who gave birth between 2013 and 2022. They characterized patients with immune-mediated inflammatory diseases based on their pregnancy and maternal characteristics, prepregnancy and prenatal immunomodulatory medication prescription patterns, and comorbidities. Among the 17% of patients who were prescribed at least one immunomodulatory medication, 48% to 70% continued treatment throughout their pregnancy. Compared with controls, patients with one or more immune-mediated inflammatory disease were at a greater risk of giving birth preterm (relative risk [RR] = 1.1, confidence interval [CI] = 1.0–1.3) and undergoing cesarean section (RR = 1.1, CI = 1.1–1.2), and their children were at higher risk for low birth weight (RR = 1.2, CI = 1.0–1.4) and being small for their gestational age (RR = 1.1, CI = 1.0–1.2). After adjusting for comorbidities, rheumatoid arthritis and/or IBD were not found to be significantly associated with an increased likelihood of preterm birth or low birth weight. The investigators emphasized that pregnancy outcomes in this patient population may rely on the nature of patients’ immune-mediated inflammatory disease and the presence of comorbidities. In a companion press release on the findings from the Institute for Systems Biology, the study authors concluded: “These results can help reshape discussions surrounding [immune-mediated inflammatory] disease and pregnancy, and bring fresh perspective to a traditionally understudied area in research.”