[en] BACKGROUND:: Infliximab (IFX) and adalimumab (ADA) are attractive treatment options in patients with inflammatory bowel disease (IBD) also during pregnancy but there is still limited data on the benefit/risk profile of IFX and ADA during pregnancy. METHODS:: This observational study assessed pregnancy outcomes in 212 women with IBD under antitumor necrosis factor alpha (TNF) treatment at our IBD unit. Pregnancy outcomes in 42 pregnancies with direct exposure to anti-TNF treatment (35 IFX, 7 ADA) were compared with that in 23 pregnancies prior to IBD diagnosis, 78 pregnancies before start of IFX, 53 pregnancies with indirect exposure to IFX, and 56 matched pregnancies in healthy women. RESULTS:: Thirty-two of the 42 pregnancies ended in live births with a median gestational age of 38 weeks (interquartile range [IQR] 37-39). There were seven premature deliveries, six children had low birth weight, and there was one stillbirth. One boy weighed 1640 g delivered at week 33, died at age of 13 days because of necrotizing enterocolitis. A total of eight abortions (one patient wish) occurred in seven women. Trisomy 18 was diagnosed in one fetus of a mother with CD at age 37 under ADA treatment (40 mg weekly) and pregnancy was terminated. Pregnancy outcomes after direct exposure to anti-TNF treatment were not different from those in pregnancies before anti-TNF treatment or with indirect exposure to anti-TNF treatment but outcomes were worse than in pregnancies before IBD diagnosis. CONCLUSIONS:: Direct exposure to anti-TNF treatment during pregnancy was not related to a higher incidence of adverse pregnancy outcomes than IBD overall. (Inflamm Bowel Dis 2011;).
Shivananda S, Lennard-Jones J, Logan R, et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut. 1996; 39: 690-697. (Pubitemid 26426470)
Vind, I, Riis L, Jess T, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol. 2006; 101: 1274-1282. (Pubitemid 43833122)
Cornish JA, Tan E, Teare J, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007; 56: 830-837. (Pubitemid 46854200)
Mahadevan U, Sandborn WJ, Li DK, et al. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study of Northern California. Gastroenterology. 2007; 133: 1106-1112. (Pubitemid 47494456)
Nguyen GC, Boudreau H, Harris ML, et al. Outcomes of obstetric hospitalizations among women with inflammatory bowel disease in the United States. Clin Gastroenterol Hepatol:. 2009; 7: 329-334.
Dominitz, JA, Young JC, Boyko EJ, et al. Outcomes of infants born to mothers with inflammatory bowel disease: a population based cohort study. Am J Gastroenterol. 2001; 96: 635-643.
Kornfeld D, Cnattingius S, Ekbom A,. Pregnancy outcomes in women with inflammatory bowel disease-a population-based cohort study. Am J Obstet Gynecol. 1997; 177: 942-946. (Pubitemid 27516071)
Fonager K, Sorensen HT, Olsen J, et al. Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries. Am J Gastroenterol. 1998; 93: 2426-2430. (Pubitemid 29018549)
Baird DD, Narendranathan M, Sandler RS,. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology. 1990; 99: 987-994. (Pubitemid 20338455)
Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet. 2002; 359: 1541-1549. (Pubitemid 34621118)
Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl Med. 2005; 353: 2462-2476. (Pubitemid 41770166)
Sandborn WJ, Hanauer SB, Rutgeerts PJ, et al. Adalimumab for maintenance treatment of Crohn's disease: results of the CLASSIC II Trial. Gut. 2007; 56: 1232-1239. (Pubitemid 47300424)
Hanauer SB, Lukas M, MacInthosh D, et al. A randomized, double-blind, placebo-controlled trial of the human anti-TNF-a monoclonal antibody adalimumab for the induction of remission in patients with moderate to severely active Crohn's disease. Gastroenterology. 2006; 130: 323-333.
Johnson DL, Jones KL, Chambers CD, et al. Pregnancy outcomes in women exposed to adalimumab: the OTIS autoimmune diseases in pregnancy project. Gastroenterology. 2009; 136: A-27.
Mahadevan U, Kane S, Sandborn WJ, et al. Intentional infliximab use during pregnancy for induction or maintenance of remission of Crohn's disease. Aliment Pharmacol Ther. 2005; 21: 733-738. (Pubitemid 40469001)
Katz JA, Antoni C, Keenan GF, et al. Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease and rheumatoid arthritis. Am J Gastroenterol. 2004; 99: 2385-2392. (Pubitemid 40039370)
Tursi A,. Effect of intentional infliximab use throughout pregnancy in inducing and maintaining remission in Crohn's disease. Dig Liver Dis. 2006; 38: 437-440.
Simister NE,. Placental transport of immunoglobulin G. Vaccine. 2003; 21: 365-369.
Vasiliauskas EA, Church JA, Silvermann N, et al. Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn. Clin Gastroenterol Hepatol. 2006; 4: 1255-1258. (Pubitemid 44512222)
Lichtenstein GR, Cohen RD, Fegan BG, et al. Safety of Inliximab in Crohn's disease: data from the 5000 patient TREAT registry. Gastroenterology. 2004; 126: A54.
Vinet E, Pineau C, Gordon C, et al. Biologic therapy and pregnancy outcomes in women with rheumatic diseases. Arthritis Rheumatism. 2009; 61: 587-592.
Thompson AM, Bizzarro MJ,. Necrotizing enterocolitis in newborns: pathogenesis, prevention and management. Drugs. 2008; 68: 1227-1238. (Pubitemid 351822112)
Jones RH, Xu S, Grunwald GK,. Continuous time Markov models for binary longitudinal data. Biometr J. 2006; 48: 411-419. (Pubitemid 43973045)
Cater JD, Ladhani A, Ricca LR, et al. A safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drug Administration database. J Rheumatol. 2009; 36: 635-641.
Winger EE, Reed JL,. Was risk properly assessed in Carter, et al's safety assessment of tumor necrosis factor antagonists during pregnancy? J Rheumatol. 2009; 36: 9.