Khan Nabeel, Asim Hamna, Lichtenstein Gary R
University of Pennsylvania Perelman School of Medicine, Department of Gastroenterology , Philadelphia, PA , USA
Expert Opin Drug Saf. 2014 Dec;13(12):1699-708. doi: 10.1517/14740338.2014.973399.
The highest incidence of inflammatory bowel disease (IBD) is seen between the second and fourth decades of life, which is the most fertile age for women. Increased disease activity has been shown to effect female fertility and pregnancy outcomes, stressing the need for drugs that can safely induce and maintain clinical remission without harming either the mother or fetus.
Anti-TNF-α agents have been shown to be effective in both inducing and maintaining remission among IBD patients. This review highlights the results of previous studies conducted on pregnant women who were exposed to anti-TNF-α agents during the course of their pregnancy. The drugs reviewed include infliximab (IFX), adalimumab (ADA), certolizumab pegol (CZP) and golimumab (GMB). Of > 200 articles reviewed, 105 were included in the manuscript based on relevance. The keywords used were anti-TNF, infliximab, adalimumab, certolizumab, golimumab, biologics, pregnancy and inflammatory bowel disease.
Anti-TNF agents have been studied extensively during pregnancy from the early case reports to the more recent prospective Pregnancy in IBD and Neonatal Outcomes study. A comprehensive review of the literature has shown that biologics can be safely used during pregnancy. In view of this safety data, it is recommended to maintain therapy during pregnancy.
炎症性肠病（IBD）的最高发病率出现在生命的第二个和第四个十年之间，而这正是女性的生育高峰期。已证明疾病活动增加会影响女性生育能力和妊娠结局，这凸显了对能够安全诱导并维持临床缓解且不伤害母亲或胎儿的药物的需求。
抗TNF-α药物已被证明在诱导和维持IBD患者缓解方面均有效。本综述重点介绍了此前针对孕期接触抗TNF-α药物的孕妇开展的研究结果。所审查的药物包括英夫利昔单抗（IFX）、阿达木单抗（ADA）、赛妥珠单抗（CZP）和戈利木单抗（GMB）。在审查的200多篇文章中，基于相关性有105篇被纳入本文。使用的关键词为抗TNF、英夫利昔单抗、阿达木单抗、赛妥珠单抗、戈利木单抗、生物制剂、妊娠和炎症性肠病。
从早期病例报告到最近的IBD妊娠与新生儿结局前瞻性研究，孕期对抗TNF药物进行了广泛研究。对文献的全面综述表明，生物制剂在孕期可安全使用。鉴于这些安全数据，建议在孕期维持治疗。
