Raja Harish, Matteson Eric L, Michet Clement J, Smith Justine R, Pulido Jose S
Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN.
Transl Vis Sci Technol. 2012 Sep 21;1(2):6. doi: 10.1167/tvst.1.2.6. eCollection 2012.
Tumor necrosis factor (TNF) inhibitors are useful in the treatment of numerous inflammatory and immunologic disorders. Since many of these conditions occur in women of childbearing age, safety during pregnancy and breastfeeding is of considerable importance.
This paper is a review of the literature on the safety of TNF inhibitors during pregnancy and breastfeeding published between 2001 and 2011.
TNF inhibitors do not appear to be associated with a high risk of teratogenicity or intrauterine death. However, a small magnitude increase in risk cannot be ruled out given the paucity of data on the subject. Although TNF inhibitor use may be associated with a higher rate of preterm delivery, this may in fact be due to an active, underlying disease. Therefore, the decision to use these medications should be made on a case-by-case basis. If the disease cannot be managed with first line agents, TNF inhibitors may be helpful in reducing the number of disease exacerbations. Nevertheless, when using TNF inhibitors, it is prudent to discontinue treatment around the third trimester when transfer across the placenta is greatest and to restart postpartum.
肿瘤坏死因子（TNF）抑制剂在多种炎症和免疫性疾病的治疗中很有用。由于这些疾病很多发生在育龄女性中，所以孕期和哺乳期的安全性相当重要。
本文是对2001年至2011年间发表的关于TNF抑制剂在孕期和哺乳期安全性的文献综述。
TNF抑制剂似乎与致畸性或宫内死亡的高风险无关。然而，鉴于关于该主题的数据匮乏，不能排除风险有小幅增加的可能性。虽然使用TNF抑制剂可能与早产率较高有关，但这实际上可能是由于潜在的活动性疾病。因此，使用这些药物的决定应逐案做出。如果一线药物无法控制疾病，TNF抑制剂可能有助于减少疾病加重的次数。尽管如此，使用TNF抑制剂时，谨慎的做法是在孕晚期（此时药物通过胎盘的转运量最大）左右停药，并在产后重新开始用药。
