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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Mette Julsgaard
  • Christian L Hvas
  • Richard B Gearry
  • Peter R Gibson
  • Jan Fallingborg
  • Miles P Sparrow
  • Bo M Bibby
  • William R Connell
  • Steven J Brown
  • Michael A Kamm
  • Ian C Lawrance
  • Thea Vestergaard
  • Lise Svenningsen
  • Mille Baekdal
  • Heidi Kammerlander
  • Alissa Walsh
  • Peter Bampton
  • Graham Radford-Smith
  • Jens Kjeldsen
  • Jane M Andrews
  • Kavitha Subramaniam
  • Gregory T Moore
  • Nanna M Jensen
  • Susan J Connor
  • Benedicte Wilson
  • Kathrine Ellard
  • Lisbet A Christensen
  • Sally J Bell

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.

OriginalsprogEngelsk
TidsskriftInflammatory Bowel Diseases
Vol/bind26
Udgave nummer1
Sider (fra-til)93-102
Antal sider10
ISSN1078-0998
DOI
StatusUdgivet - 1 jan. 2020

Bibliografisk note

© 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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