Anti-TNF therapy for IBD safe in pregnancy

Last Updated: 2015-05-25

By Will Boggs MD

NEW YORK (Reuters Health) - Anti-TNF therapy for inflammatory bowel disease (IBD) during pregnancy appears to be safe for mother and fetus, according to a prospective study.

"We were not surprised that our analyses showed no increased risk of disease relapse after anti-TNF cessation during pregnancy; however, we were pleasantly surprised that the health outcomes of anti-TNF exposed children were comparable to the non-exposed children born to non-IBD controls," Dr. Alison de Lima from Erasmus University Medical Center Rotterdam in The Netherlands told Reuters Health by email. "This is important news for physicians treating pregnant IBD women, but even more so in the reassurance of IBD mothers-to-be."

Anti-TNF agents are US Food and Drug Administration (FDA) category B and therefore considered relatively low risk during pregnancy in terms of teratogenicity, but limited data are available on the immunological and developmental consequences of anti-TNF exposure in utero.

Dr. de Lima and colleagues followed 106 women with IBD who had 83 completed pregnancies, including 51 pregnancies where women in sustained remission stopped anti-TNF before week 25 (stop group) and 32 pregnancies where women continued anti-TNF beyond week 30 (continue group). They compared the outcomes of these pregnancies with those of 804 women without IBD (control group).

There were no differences in relapse rates after week 22 between the stop group and the continue group (five relapses in each group), according to the May 12th Gut online report.

Most birth outcomes (birth weight, gestational age at birth, congenital abnormalities, mode of delivery) did not differ between the stop and continue groups, though gestational age at birth was significantly lower in children of women with IBD disease activity during pregnancy (mean, 38.0 weeks) than in children of IBD patients without disease activity during pregnancy (mean, 39.3 weeks).

Compared with non-IBD controls, children born to mothers with IBD treated with anti-TNF during pregnancy had significantly lower birth weights (a difference of nearly 200 g) and shorter gestational ages at birth (a difference of 1.1 weeks), but there were no differences in the prevalence of small for gestational age babies between the groups or in the rate of congenital abnormalities.

There were no differences between the stop group and continue group or between the anti-TNF exposed children and controls in growth, infections, allergies, and eczema during the first year of life.

"The most important factor for deciding to stop or continue should be the sustained remission status of the patient," Dr. de Lima said. "If there is disease remission from three months prior to conception until gestational week 20, the physician can safely decide to discontinue anti-TNF in gestational week 22."

"Balancing between adequately treating IBD mothers and simultaneously not harming the fetus can be very difficult," Dr. de Lima said. "We hope that with this study we added to the available data and that we can aid physicians treating pregnant IBD women in their decision making concerning anti-TNF during pregnancy."

SOURCE: http://bmj.co/1FbwiKu

Gut 2015.