The Distribution of Congenital Anomalies Within the VACTERL Association Among Tumor Necrosis Factor Antagonist-exposed Pregnancies Is Similar to the General Population

Objective. To compare the distribution of congenital anomalies within the VACTERL association (vertebral defects, anal atresia, cardiac, tracheoesophageal, renal, and limb abnormalities) between patients exposed to tumor necrosis factor-alpha (TNF-alpha) antagonist and the general population. Methods. Analysis for comparison of proportional differences to a previous publication between anomaly subgroups, according to subgroup definitions of the European Surveillance of Congenital Anomalies (EUROCAT), a population-based database. Results. Most EUROCAT subgroups belonging to the VACTERL association contained only one or 2 records of TNF-a antagonist exposure, so comparison of proportions was imprecise. Only the category limb abnormalities showed a significantly higher proportion in the general population. Conclusion. The high number of congenital anomalies belonging to the VACTERL association from a report of pregnancies exposed to TNF-alpha antagonists could not be confirmed using a population-based congenital anomaly database. (First Release July 1 2011; J Rheumatol 2011;38:1871-4; doi:10.3899/jrheum.101316)