Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Medicine, Horsens Hospital, Horsens, Denmark.
Inflamm Bowel Dis. 2020 Jan 1;26(1):93-102. doi: 10.1093/ibd/izz110.
Active inflammatory bowel disease (IBD) adversely affects pregnancy outcomes. Little is known about the risk of relapse after stopping anti-tumor necrosis factor (anti-TNF) treatment during pregnancy. We assessed the risk of relapse before delivery in women who discontinued anti-TNF treatment before gestational week (GW) 30, predictors of reduced infant birth weight, a marker associated with long-term adverse outcomes, and rates and satisfaction with counseling.
Pregnant women with IBD receiving anti-TNF treatment were prospectively invited to participate in an electronic questionnaire carried out in 22 hospitals in Denmark, Australia, and New Zealand from 2011 to 2015. Risk estimates were calculated, and birth weight was investigated using t tests and linear regression.
Of 175 women invited, 153 (87%) responded. In women in remission, the relapse rate did not differ significantly between those who discontinued anti-TNF before GW 30 (1/46, 2%) compared with those who continued treatment (8/74, 11%; relative risk, 0.20; 95% confidence interval [CI], 0.02 to 1.56; P = 0.08). Relapse (P = 0.001) and continuation of anti-TNF therapy after GW 30 (P = 0.007) were independently associated with reduced mean birth weight by 367 g (95% CI, 145 to 589 g; relapse) and 274 g (95% CI, 77 to 471 g; anti-TNF exposure after GW 30). Of 134 (88%) women who received counseling, 116 (87%) were satisfied with the information provided.
To minimize fetal exposure in women in remission, discontinuation of anti-TNF before GW 30 seems safe. Relapse and continuation of anti-TNF therapy after GW 30 were each independently associated with lower birth weight, although without an increased risk for birth weight <2500 g. Most women received and were satisfied with counseling.
活动性炎症性肠病（IBD）会对妊娠结局产生不良影响。对于在妊娠期间停止使用抗肿瘤坏死因子（anti-TNF）治疗后复发的风险知之甚少。我们评估了在妊娠第 30 周前停止 anti-TNF 治疗的女性在分娩前复发的风险，以及与长期不良结局相关的降低婴儿出生体重的预测因素，以及与长期不良结局相关的标记物，以及咨询的发生率和满意度。
2011 年至 2015 年，丹麦、澳大利亚和新西兰的 22 家医院前瞻性邀请接受 anti-TNF 治疗的 IBD 孕妇参与电子问卷调查。计算风险估计值，并使用 t 检验和线性回归调查出生体重。
在 175 名受邀女性中，153 名（87%）做出回应。在缓解期的女性中，在 GW 30 之前停止 anti-TNF 的女性（46 例中的 1 例，2%）与继续治疗的女性（74 例中的 8 例，11%；相对风险，0.20；95%置信区间[CI]，0.02 至 1.56；P = 0.08）相比，复发率无显著差异。复发（P = 0.001）和 GW 30 后继续 anti-TNF 治疗（P = 0.007）与平均出生体重分别降低 367g（95%CI，145 至 589g；复发）和 274g（95%CI，77 至 471g；GW 30 后抗-TNF 暴露）独立相关。在 134 名（88%）接受咨询的女性中，有 116 名（87%）对提供的信息表示满意。
为了尽量减少缓解期女性的胎儿暴露，在 GW 30 之前停止使用 anti-TNF 似乎是安全的。GW 30 后复发和继续使用 anti-TNF 治疗均与出生体重降低独立相关，尽管出生体重<2500g 的风险没有增加。大多数女性都接受了咨询，并对咨询表示满意。
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