Anti-TNF therapy during pregnancy

Inflamm Bowel Dis. 2019 May 29. pii: izz110. doi: 10.1093/ibd/izz110. [Epub ahead
of print]

Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease: Effects of
Therapeutic Strategies on Disease Behavior and Birth Outcomes.

Julsgaard M et.al.

Author information: 
(1)Department of Hepatology and Gastroenterology, Aarhus University Hospital,
Aarhus, Denmark.

BACKGROUND: Active inflammatory bowel disease (IBD) adversely affects pregnancy
outcomes. Little is known about the risk of relapse after stopping anti-tumor
necrosis factor (anti-TNF) treatment during pregnancy. We assessed the risk of
relapse before delivery in women who discontinued anti-TNF treatment before
gestational week (GW) 30, predictors of reduced infant birth weight, a marker
associated with long-term adverse outcomes, and rates and satisfaction with
counseling.
METHODS: Pregnant women with IBD receiving anti-TNF treatment were prospectively 
invited to participate in an electronic questionnaire carried out in 22 hospitals
in Denmark, Australia, and New Zealand from 2011 to 2015. Risk estimates were
calculated, and birth weight was investigated using t tests and linear
regression.
RESULTS: Of 175 women invited, 153 (87%) responded. In women in remission, the
relapse rate did not differ significantly between those who discontinued anti-TNF
before GW 30 (1/46, 2%) compared with those who continued treatment (8/74, 11%;
relative risk, 0.20; 95% confidence interval [CI], 0.02 to 1.56; P = 0.08).
Relapse (P = 0.001) and continuation of anti-TNF therapy after GW 30 (P = 0.007) 
were independently associated with reduced mean birth weight by 367 g (95% CI,
145 to 589 g; relapse) and 274 g (95% CI, 77 to 471 g; anti-TNF exposure after GW
30). Of 134 (88%) women who received counseling, 116 (87%) were satisfied with
the information provided.
CONCLUSIONS: To minimize fetal exposure in women in remission, discontinuation of
anti-TNF before GW 30 seems safe. Relapse and continuation of anti-TNF therapy
after GW 30 were each independently associated with lower birth weight, although 
without an increased risk for birth weight <2500 g. Most women received and were 
satisfied with counseling.

© 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All
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DOI: 10.1093/ibd/izz110 
PMID: 31141607