TY - JOUR
T1 - Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease
T2 - Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes
AU - Julsgaard, Mette
AU - Hvas, Christian L
AU - Gearry, Richard B
AU - Gibson, Peter R
AU - Fallingborg, Jan
AU - Sparrow, Miles P
AU - Bibby, Bo M
AU - Connell, William R
AU - Brown, Steven J
AU - Kamm, Michael A
AU - Lawrance, Ian C
AU - Vestergaard, Thea
AU - Svenningsen, Lise
AU - Baekdal, Mille
AU - Kammerlander, Heidi
AU - Walsh, Alissa
AU - Boysen, Trine
AU - Bampton, Peter
AU - Radford-Smith, Graham
AU - Kjeldsen, Jens
AU - Andrews, Jane M
AU - Subramaniam, Kavitha
AU - Moore, Gregory T
AU - Jensen, Nanna M
AU - Connor, Susan J
AU - Wildt, Signe
AU - Wilson, Benedicte
AU - Ellard, Kathrine
AU - Christensen, Lisbet A
AU - Bell, Sally J
N1 - � 2019 Crohn�s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
U2 - 10.1093/ibd/izz110
DO - 10.1093/ibd/izz110
M3 - Article
C2 - 31141607
SN - 1078-0998
VL - 26
SP - 93
EP - 102
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 1
ER -