Physicians treating patients with Crohn’s disease and ulcerative colitis will often need to care for them throughout pregnancy and deal with the surrounding issues of fertility, childbirth, and sexuality. Patients often worry about continuing medications during pregnancy and feel particularly at risk for poor birth outcomes. However, because pregnancy outcomes are most closely tied to disease activity at the time of conception, patients who are in remission when they conceive will have the most successful pregnancies. The overriding principle in treating pregnant patients with inflammatory bowel disease (IBD) is continued and close surveillance of disease activity, with aggressive medical, and if indicated, surgical treatment. With few exceptions, medicines used to induce remission before pregnancy should be continued throughout pregnancy. Pregnant women with active IBD should be followed by a gastroenterologist with experience in the issues surrounding pregnancy, and by an obstetrician with access to a tertiary referral center. Properly treated and followed, patients with IBD can expect outcomes from their pregnancies that approximate those of patients without the disease.