Roseira Joana, Ramos Jaime
Serviço de Gastrenterologia. Hospital de Portimão. Centro Hospitalar Universitário do Algarve. Portimão. Portugal.
Serviço de Gastrenterologia. Hospital de Santo António dos Capuchos. Centro Hospitalar de Lisboa Central. Lisboa. Portugal.
Acta Med Port. 2019 Apr 30;32(4):305-312. doi: 10.20344/amp.11482.
Inflammatory bowel disease activity is associated with adverse pregnancy outcomes. Anti-tumor necrosis factor α therapy is often required to treat flares and to maintain disease remission. However, there are concerns regarding treatment with these agents during pregnancy, as they actively cross the placental barrier.
Studies regarding anti-tumor necrosis factor α therapy during pregnancy were identified from PubMed from 1958 to January 2018. The reference lists of the selected studies were reviewed to identify complementary publications.
Anti-tumor necrosis factor α agents are efficient treatments for moderate-to-severe inflammatory bowel disease and may ensure remission during pregnancy. Although these drugs cross the placenta, they are considered safe for both the mother and the fetus. Furthermore, up-to-date guidelines support therapy continuation during pregnancy aiming for disease control. The same guidelines also consider stopping treatment during the third trimester to limit maternal-fetal drug transfer. However, data shows that this strategy does not completely prevent fetus exposure. In addition, stopping treatment incurs in risk of disease flare and threatens subsequent therapy response. Fetus drug exposure has not showed an association with adverse childhood development. However, as infant drug levels could be detected up to seven months after birth, postponement of live virus vaccination is recommended.
There should be no disagreement among the medical community as to the need to maintain therapy aiming for disease remission during gestation in inflammatory bowel disease. Anti-tumor necrosis factor α agents are safe for both the mother and the fetus.
炎症性肠病活动与不良妊娠结局相关。治疗病情发作和维持疾病缓解通常需要使用抗肿瘤坏死因子α疗法。然而，由于这些药物可有效穿过胎盘屏障，人们对孕期使用这些药物存在担忧。
从1958年至2018年1月的PubMed中检索关于孕期抗肿瘤坏死因子α疗法的研究。对所选研究的参考文献列表进行审查以识别补充出版物。
抗肿瘤坏死因子α药物是治疗中度至重度炎症性肠病的有效方法，可确保孕期病情缓解。虽然这些药物可穿过胎盘，但它们被认为对母亲和胎儿均安全。此外，最新指南支持孕期持续治疗以控制疾病。同样的指南也考虑在孕晚期停止治疗以限制母婴药物转移。然而，数据显示该策略并不能完全防止胎儿接触药物。此外，停止治疗会带来疾病复发风险并威胁后续治疗反应。胎儿药物接触与儿童期不良发育并无关联。然而，由于出生后七个月内均可检测到婴儿体内的药物水平，因此建议推迟活病毒疫苗接种。
医学界对于在妊娠期维持治疗以缓解炎症性肠病病情的必要性应不存在分歧。抗肿瘤坏死因子α药物对母亲和胎儿均安全。
