NEW findings suggest that there is no increased risk of adverse birth outcomes when using TNF inhibitors such as infliximab and adalimumab in females with inflammatory bowel disease (IBD) who are pregnant. These treatments are common second-line therapies for IBD; however, European consensus guidelines advise to stop these around gestational Week 24, as the drugs can cross the placental barrier. Yet North American guidelines recommend continuing the treatment for the duration of the pregnancy, as IBD flares can lead to adverse pregnancy outcomes such as stillbirth and preterm delivery.
Antoine Meyer, Hôpital Bicêtre, Le Kremlin-Bicêtre, France, and Université Paris-Saclay, France, and colleagues decided to examine records of female patients with IBD in the French national health system from 2010–2020 to resolve this disparity. They compared the outcomes of 2,403 patients who had continued taking TNF inhibitors after Week 24 and who appeared to be in stable remission with 2,890 patients who had stopped the treatment by Week 24. In the group who continued the drugs, renewed IBD activity from gestational Week 32 to 6 months postpartum was recorded in 35.8% of patients, versus 39.0% of those who stopped the treatment. The rates of low birthweight and pregnancy-related hospitalisation were similar in both groups. The ‘continue’ group showed a higher rate of stillbirths (nine versus five) and caesarean sections (35.7% versus 33.1%); however, these were not statistically significant. The rate of preterm birth was higher in the ‘stop’ group (8.9% versus 7.6%). Those who continued the treatment were also less likely to experience a flare up of the disease for the remainder of the pregnancy and 6-months postpartum.
Another concern with fetal exposure to TNF inhibitors was the risk that the children would be more vulnerable to infections; however, the team found no significant difference in serious infection rates. Limitations to the study were the possibility of gaps and errors in the national database. Meyer concluded: “Continuation of anti-TNF after 24 weeks of pregnancy seems beneficial regarding IBD activity and prematurity, while not affecting neonatal outcomes and susceptibility to serious infections in the offspring.”
