Pregnancy and newborn outcome of mothers with inflammatory bowel diseases exposed to anti-TNF-α therapy during pregnancy: three-center study

Objective. Substantial number of women with inflammatory bowel disease (IBD) conceives while on anti-TNF-alpha therapy. The aim was to assess the safety and efficacy of anti-TNF-alpha treatment during pregnancy and to analyze relationship of neonatal and maternal anti-TNF-alpha levels at delivery with gestational age at the last exposure. Material and methods. Women with IBD exposed to anti-TNF-alpha therapy during pregnancy were included. Data on anti-TNF-alpha treatment, disease activity, concomitant medication, pregnancy and newborn outcome were recorded. Anti-TNF-alpha levels from cord blood were assessed by ELISA. Results. Forty-one pregnancies (27 Crohn's disease; 14 ulcerative colitis) were exposed to infliximab (IFX; 32) and adalimumab (ADA; 9). Ten (24%) women had active disease at conception and 31 (76%) were in remission with 3 patients experiencing relapse during pregnancy. Anti-TNF-alpha therapy started prior to and after conception in 32 and 9 women, respectively. There were 34 (83%) live births (median birth weight 3145 g) of which 28 were at-term and 6 preterm deliveries. Five (12%) pregnancies ended in spontaneous and two in therapeutic abortion. No congenital malformations except for one case of hip dysplasia were observed. Similarly, no serious perinatal complication occurred. IFX cord levels measured in 11 children positively correlated with gestational week at the last drug administration and maternal levels at delivery, while no such correlation was found in case of ADA. Conclusions. The results confirm that anti-TNFs are effective and safe during pregnancy. A positive correlation between IFX cord levels and gestational week of last exposure as well as maternal serum levels was observed.