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

被引：32

作者：

Julsgaard, Mette ^{[1
,2
,3
,4
]}

Hvas, Christian L. ^{[1
]}

Gearry, Richard B. ^{[5
]}

Gibson, Peter R. ^{[6
,7
]}

Fallingborg, Jan ^{[8
]}

Sparrow, Miles P. ^{[6
,7
]}

Bibby, Bo M. ^{[9
]}

Connell, William R. ^{[3
,4
]}

Brown, Steven J. ^{[3
,4
]}

Kamm, Michael A. ^{[3
,4
]}

Lawrance, Ian C. ^{[10
,11
]}

Vestergaard, Thea ^{[1
]}

Svenningsen, Lise ^{[2
,12
]}

Baekdal, Mille ^{[13
]}

Kammerlander, Heidi ^{[14
,15
]}

Walsh, Alissa ^{[16
]}

Boysen, Trine ^{[17
]}

Bampton, Peter ^{[18
]}

Radford-Smith, Graham ^{[19
]}

Kjeldsen, Jens ^{[15
]}

Andrews, Jane M. ^{[20
]}

Subramaniam, Kavitha ^{[21
]}

Moore, Gregory T. ^{[22
,23
]}

Jensen, Nanna M. ^{[24
]}

Connor, Susan J. ^{[25
,26
]}

Wildt, Signe ^{[27
]}

Wilson, Benedicte ^{[28
]}

Ellard, Kathrine ^{[29
]}

Christensen, Lisbet A. ^{[1
,30
]}

Bell, Sally J. ^{[3
,4
,22
,23
]}

机构：

[1] Aarhus Univ Hosp, Dept Hepatol & Gastroenterol, Palle Juul Jensens Blvd 99,Level 1,Fix Point C117, DK-8200 Aarhus N, Denmark

[2] Horsens Hosp, Dept Med, Horsens, Denmark

[3] St Vincents Hosp, Dept Gastroenterol, Melbourne, Vic, Australia

[4] Univ Melbourne, Melbourne, Vic, Australia

[5] Univ Otago, Christchurch Hosp, Dept Med, Christchurch, New Zealand

[6] Alfred Hosp, Dept Gastroenterol, Melbourne, Vic, Australia

[7] Monash Univ, Melbourne, Vic, Australia

[8] Aalborg Univ Hosp, Dept Gastroenterol, Aalborg, Denmark

[9] Univ Aarhus, Dept Biostat, Aarhus, Denmark

[10] Univ Western Australia, Harry Perkins Inst Med Res, Sch Med & Pharmacol, Murdoch, WA, Australia

[11] St John God Hosp, Ctr Inflammatory Bowel Dis, Subiaco, WA, Australia

[12] Herning Hosp, Dept Med, Herning, Denmark

[13] Univ Copenhagen, Hvidovre Hosp, Div Med, Gastrounit, Hvidovre, Denmark

[14] Hosp Southwest Jutland, Dept Gastroenterol, Esbjerg, Denmark

[15] Odense Univ Hosp, Dept Gastroenterol, Odense, Denmark

[16] St Vincents Hosp, Dept Gastroenterol, Sydney, NSW, Australia

[17] Univ Copenhagen, Herlev Hosp, Div Med, Gastrounit, Herlev, Denmark

[18] Flinders Med Ctr, Dept Gastroenterol, Bedford Pk, SA, Australia

[19] Univ Queensland, Royal Brisbane & Womens Hosp, Inflammatory Bowel Dis Unit, Sch Med, Brisbane, Qld, Australia

[20] Univ Adelaide, Royal Adelaide Hosp, Dept Gastroenterol & Hepatol, Adelaide, SA, Australia

[21] Australian Natl Univ, Canberra Hosp, Gastroenterol & Hepatol Unit, Canberra, ACT, Australia

[22] Monash Univ, Monash Hlth, Dept Gastroenterol, Melbourne, Vic, Australia

[23] Monash Univ, Sch Clin Sci, Melbourne, Vic, Australia

[24] Univ Copenhagen, Bispebjerg Hosp, Abdominalctr K, Copenhagen, Denmark

[25] Sydney Univ NSW, Liverpool Hosp, Dept Gastroenterol, Sydney, NSW, Australia

[26] Ingham Inst Appl Med Res, Sydney, NSW, Australia

[27] Zealand Univ Hosp, Dept Med, Koge, Denmark

[28] Nykobing Falster Hosp, Dept Internal Med, Nykobing, Denmark

[29] Mater Hosp, Dept Gastroenterol, Sydney, NSW, Australia

[30] Aarhus Univ Hosp, Inst Clin Med, Aarhus, Denmark

来源：

INFLAMMATORY BOWEL DISEASES | 2020年 / 26卷 / 01期

关键词：

anti-tumor necrosis factor alpha; counseling; inflammatory bowel disease; pregnancy; pregnancy outcome; NECROSIS FACTOR AGENTS; MEDICAL-TREATMENT; FETAL-GROWTH; MANAGEMENT; ADHERENCE; CYTOKINES; KNOWLEDGE; CONSENSUS; EXPOSURE; MOTHERS;

D O I：

10.1093/ibd/izz110

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Discontinuation of anti-TNF before gestational week 30 did not increase the risk of relapse in the third trimester. Relapse and continuation of anti-TNF throughout pregnancy were each independently associated with lower birth weight, a marker associated with long-term adverse outcomes. 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.

引用

页码：93 / 102

页数：10