Daham Nujud, AlMuqrin Abdullah, Madani Abdulaziz, AlSaif Fahad
Department of Dermatology, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia.
Department of Dermatology, Prince Mohammed Bin Abdulaziz Medical City, Riyadh, Saudi Arabia.
Biologics. 2020 Nov 11;14:127-129. doi: 10.2147/BTT.S273762. eCollection 2020.
Adalimumab is a fully human, recombinant, IgG1 monoclonal antibody that targets tumor necrosis factor-alpha (TNF-alpha). It has been established that adalimumab can cross the placenta and can be detected in the fetal circulation for up to 6 months postpartum. However, clinical studies have failed to show any consistent or specific adverse fetal outcomes from maternal exposure to adalimumab during pregnancy. In our report, we present a case of fetal acrania (exencephaly) in the setting of a pregnant female taking adalimumab prior to and during pregnancy. Exencephaly is a neural tube defect (NTD) that results from failure of closure of the neural fold. It is true that there were other risk factors that might have contributed to our patient's unfortunate outcome. For example, she did not take folic acid supplementation prior to or during her pregnancy. Nonetheless, studies have shown that folic acid deficiency alone is not sufficient to lead to the development of NTDs. Our patient's exposure to adalimumab during her pregnancy might have added to the risk in her situation. Our report aims to inform clinicians of that possible risk and to stimulate them to report any similar outcomes.
阿达木单抗是一种全人源重组IgG1单克隆抗体，靶向肿瘤坏死因子-α（TNF-α）。已证实阿达木单抗可穿过胎盘，产后长达6个月可在胎儿循环中检测到。然而，临床研究未能显示孕期母亲接触阿达木单抗会导致任何一致或特定的不良胎儿结局。在我们的报告中，我们呈现了一例在孕期及孕前行阿达木单抗治疗的孕妇出现胎儿无脑儿（露脑畸形）的病例。露脑畸形是一种神经管缺陷（NTD），由神经褶闭合失败导致。诚然，还有其他可能导致我们患者不幸结局的风险因素。例如，她在孕期及孕前均未补充叶酸。尽管如此，研究表明单纯叶酸缺乏不足以导致神经管缺陷的发生。我们的患者在孕期接触阿达木单抗可能增加了其情况中的风险。我们的报告旨在告知临床医生这种可能的风险，并促使他们报告任何类似的结局。
