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

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, Trine Boysen, Peter Bampton, Graham Radford-Smith, Jens KjeldsenJane M. Andrews, Kavitha Subramaniam, Gregory T. Moore, Nanna M. Jensen, Susan J. Connor, Signe Wildt, Benedicte Wilson, Kathrine Ellard, Lisbet A. Christensen, Sally J. Bell

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    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
    Pages (from-to)93-102
    Number of pages10
    JournalInflammatory Bowel Diseases
    Volume26
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2020

    Keywords

    • anti-tumor necrosis factor alpha
    • counseling
    • inflammatory bowel disease
    • pregnancy
    • pregnancy outcome

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    Julsgaard, M., Hvas, C. L., Gearry, R. B., Gibson, P. R., Fallingborg, J., Sparrow, M. P., Bibby, B. M., Connell, W. R., Brown, S. J., Kamm, M. A., Lawrance, I. C., Vestergaard, T., Svenningsen, L., Baekdal, M., Kammerlander, H., Walsh, A., Boysen, T., Bampton, P., Radford-Smith, G., ... Bell, S. J. (2020). Anti-TNF Therapy in Pregnant Women with Inflammatory Bowel Disease: Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes. Inflammatory Bowel Diseases, 26(1), 93-102. https://doi.org/10.1093/ibd/izz110