Skomsvoll Johan F, Wallenius Marianne, Koksvik Hege S, Rødevand Erik, Salvesen Kjell A, Spigset Olav, Kvien Tore K
Department of Obstetrics, Trondheim University Hospital, Trondheim, Norway.
Nat Clin Pract Rheumatol. 2007 Mar;3(3):156-64. doi: 10.1038/ncprheum0426.
Tumor necrosis factor (TNF) antagonists are widely used to reduce disease activity and joint damage, and to improve health-related quality of life in patients suffering from rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. To date, no increased risk of embryotoxicity or teratogenicity, or adverse pregnancy outcome (such as birth defects, premature birth, and low birth weight) has been reported in patients with inflammatory arthropathies treated with anti-TNF therapy, compared with the general population. However, the available data are limited, and methotrexate, which is commonly used in combination with anti-TNF drugs, is teratogenic. Until more data are available, no firm conclusions can be reached regarding the safety of anti-TNF therapy in pregnancy. Nevertheless, in selected cases where there is high disease activity, anti-TNF therapy might be recommended, depending on the results of individual risk-benefit analyses. Fully informed consent from the mother is needed in such cases. Anti-TNF agents are not usually used during lactation, although the risk of toxicity is probably negligible.
肿瘤坏死因子（TNF）拮抗剂被广泛用于降低疾病活动度和关节损伤，并改善类风湿关节炎、强直性脊柱炎或银屑病关节炎患者的健康相关生活质量。迄今为止，与普通人群相比，接受抗TNF治疗的炎性关节病患者中，尚未报告胚胎毒性或致畸性增加，或不良妊娠结局（如出生缺陷、早产和低出生体重）。然而，现有数据有限，且常用于与抗TNF药物联合使用的甲氨蝶呤具有致畸性。在获得更多数据之前，无法就抗TNF治疗在妊娠中的安全性得出确凿结论。尽管如此，在某些疾病活动度高的特定病例中，根据个体风险效益分析结果，可能会推荐抗TNF治疗。在这种情况下，需要母亲充分知情同意。抗TNF药物通常不在哺乳期使用，尽管毒性风险可能微不足道。
