Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Inflamm Bowel Dis. 2011 Sep;17(9):1846-54. doi: 10.1002/ibd.21583. Epub 2011 Jan 6.
Infliximab (IFX) and adalimumab (ADA) are attractive treatment options in patients with inflammatory bowel disease (IBD) also during pregnancy but there is still limited data on the benefit/risk profile of IFX and ADA during pregnancy.
This observational study assessed pregnancy outcomes in 212 women with IBD under antitumor necrosis factor alpha (TNF) treatment at our IBD unit. Pregnancy outcomes in 42 pregnancies with direct exposure to anti-TNF treatment (35 IFX, 7 ADA) were compared with that in 23 pregnancies prior to IBD diagnosis, 78 pregnancies before start of IFX, 53 pregnancies with indirect exposure to IFX, and 56 matched pregnancies in healthy women.
Thirty-two of the 42 pregnancies ended in live births with a median gestational age of 38 weeks (interquartile range [IQR] 37-39). There were seven premature deliveries, six children had low birth weight, and there was one stillbirth. One boy weighed 1640 g delivered at week 33, died at age of 13 days because of necrotizing enterocolitis. A total of eight abortions (one patient wish) occurred in seven women. Trisomy 18 was diagnosed in one fetus of a mother with CD at age 37 under ADA treatment (40 mg weekly) and pregnancy was terminated. Pregnancy outcomes after direct exposure to anti-TNF treatment were not different from those in pregnancies before anti-TNF treatment or with indirect exposure to anti-TNF treatment but outcomes were worse than in pregnancies before IBD diagnosis.
Direct exposure to anti-TNF treatment during pregnancy was not related to a higher incidence of adverse pregnancy outcomes than IBD overall.
英夫利昔单抗（IFX）和阿达木单抗（ADA）是炎症性肠病（IBD）患者的有吸引力的治疗选择，在怀孕期间也是如此，但关于 IFX 和 ADA 在怀孕期间的获益/风险状况的数据仍然有限。
本观察性研究评估了我们的 IBD 科 212 名接受抗肿瘤坏死因子-α（TNF）治疗的 IBD 女性患者的妊娠结局。将 42 例直接接受抗 TNF 治疗（35 例 IFX，7 例 ADA）的妊娠结局与 23 例 IBD 诊断前、78 例 IFX 开始前、53 例间接接受 IFX 治疗的妊娠和 56 例健康妇女匹配的妊娠进行比较。
42 例妊娠中有 32 例以活产结束，中位孕龄为 38 周（四分位距 [IQR] 37-39）。有 7 例早产，6 例婴儿出生体重低，有 1 例死胎。一名体重 1640 克的男孩在 33 周时分娩，因坏死性小肠结肠炎在出生后 13 天死亡。7 名妇女中有 1 人因个人意愿共发生 8 例流产。一名患有 CD 的 37 岁女性在 ADA 治疗（每周 40 毫克）下胎儿被诊断为 18 三体，妊娠终止。直接暴露于抗 TNF 治疗后的妊娠结局与抗 TNF 治疗前或间接暴露于抗 TNF 治疗后的妊娠结局无差异，但结局比 IBD 诊断前的妊娠更差。
与 IBD 整体相比，怀孕期间直接接触抗 TNF 治疗与不良妊娠结局的发生率增加无关。
