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

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  • Mette Julsgaard
  • Christian L Hvas
  • Richard B Gearry, Department of Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand.
  • ,
  • Peter R Gibson, Department of Gastroenterology, Alfred Hospital, and Monash University, Melbourne, VIC, Australia.
  • ,
  • Jan Fallingborg
  • Miles P Sparrow, Department of Gastroenterology, Alfred Hospital, and Monash University, Melbourne, VIC, Australia.
  • ,
  • Bo M Bibby
  • William R Connell, Department of Gastroenterology, St Vincent's Hospital, and University of Melbourne, Melbourne, Australia.
  • ,
  • Steven J Brown, Department of Gastroenterology, St Vincent's Hospital, and University of Melbourne, Melbourne, Australia.
  • ,
  • Michael A Kamm, Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark.
  • ,
  • Ian C Lawrance, Centre for inflammatory Bowel Diseases, Saint John of God Hospital, Subiaco, WA, Australia.
  • ,
  • Thea Vestergaard
  • Lise Svenningsen
  • Mille Baekdal, Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
  • ,
  • Heidi Kammerlander, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
  • ,
  • Alissa Walsh, Department of Gastroenterology, St. Vincent's Hospital, Sydney, NSW, Australia.
  • ,
  • Trine Boysen, Gastrounit, Medical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
  • ,
  • Peter Bampton, Department of Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia.
  • ,
  • Graham Radford-Smith, Inflammatory Bowel Diseases Unit, Royal Brisbane & Women's Hospital, University of Queensland School of Medicine, Brisbane, QLD, Australia.
  • ,
  • Jens Kjeldsen
  • Jane M Andrews, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.
  • ,
  • Kavitha Subramaniam, Gastroenterology and Hepatology Unit, The Canberra Hospital, Australian National University, Canberra, ACT, Australia.
  • ,
  • Gregory T Moore, Department of Gastroenterology, Monash Health, and School of Clinical Sciences Monash University, Melbourne, VIC, Australia.
  • ,
  • Nanna M Jensen, Abdominalcenter K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
  • ,
  • Susan J Connor, Department of Gastroenterology, Liverpool Hospital, Sydney, University of NSW, and Ingham Institute of Applied Medical Research, Sydney, Australia.
  • ,
  • Signe Wildt, Medical Department, Zealand University Hospital, Køge, Denmark.
  • ,
  • Benedicte Wilson, Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing, Denmark.
  • ,
  • Kathrine Ellard, Mater Hospital, Department of Gastroenterology, Sydney, Australia.
  • ,
  • Lisbet A Christensen
  • Sally J Bell, Department of Gastroenterology, Monash Health, and School of Clinical Sciences Monash University, Melbourne, VIC, Australia.

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.

Original languageEnglish
JournalInflammatory Bowel Diseases
ISSN1078-0998
DOIs
Publication statusE-pub ahead of print - 29 May 2019

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