EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, and Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France (A.M.).
EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.).
Ann Intern Med. 2022 Oct;175(10):1374-1382. doi: 10.7326/M22-0819. Epub 2022 Sep 27.
Continuation of biologics for inflammatory disorders during pregnancy is still a difficult decision. Many women with inflammatory bowel diseases (IBDs) stop anti-tumor necrosis factor (anti-TNF) treatment after 24 weeks.
To evaluate the benefits and risks of anti-TNF continuation after 24 weeks of pregnancy for mothers with IBD and their offspring.
Target trial emulation between 2010 and 2020.
Nationwide population-based study using the Système National des Données de Santé.
All pregnancies with birth exposed to anti-TNF between conception and 24 weeks of pregnancy in women with IBD.
Continuation of anti-TNF after 24 weeks of pregnancy.
Occurrence of maternal IBD relapse up to 6 months after pregnancy, adverse pregnancy outcomes, and serious infections in the offspring during the first 5 years of life was compared according to anti-TNF continuation after 24 weeks of pregnancy using inverse probability-weighted marginal models.
A total of 5293 pregnancies were included; among them, anti-TNF treatment was discontinued before 24 weeks for 2890 and continued beyond 24 weeks for 2403. Continuation of anti-TNF was associated with decreased frequencies of maternal IBD relapse (35.8% vs. 39.0%; adjusted risk ratio [aRR], 0.93 [95% CI, 0.86 to 0.99]) and prematurity (7.6% vs. 8.9%; aRR, 0.82 [CI, 0.68 to 0.99]). No difference according to anti-TNF continuation was found regarding stillbirths (0.4% vs. 0.2%; aRR, 2.16 [CI, 0.64 to 7.81]), small weight for gestational age births (13.1% vs. 12.9%; aRR, 1.01 [CI, 0.88 to 1.17]), and serious infections in the offspring (54.2 vs. 50.2 per 1000 person-years; adjusted hazard ratio, 1.08 [CI, 0.94 to 1.25]).
Algorithms rather than clinical data were used to identify patients with IBD, pregnancies, and serious infections.
Continuation of anti-TNF after 24 weeks of pregnancy appears beneficial regarding IBD activity and prematurity, while not affecting neonatal outcomes and serious infections in the offspring.
None.
在怀孕期间继续使用生物制剂治疗炎症性疾病仍然是一个困难的决定。许多患有炎症性肠病（IBD）的女性在 24 周后停止使用抗肿瘤坏死因子（anti-TNF）治疗。
评估 IBD 母亲及其后代在妊娠 24 周后继续使用抗 TNF 治疗的益处和风险。
2010 年至 2020 年的目标试验模拟。
使用国家健康数据系统进行全国性基于人群的研究。
所有在 IBD 女性受孕至妊娠 24 周期间暴露于抗 TNF 药物的妊娠。
妊娠 24 周后继续使用抗 TNF。
使用逆概率加权边际模型比较妊娠后 6 个月内母亲 IBD 复发、不良妊娠结局和儿童在出生后 5 年内发生严重感染的发生率，根据妊娠 24 周后继续使用抗 TNF 的情况进行分析。
共纳入 5293 例妊娠；其中，2890 例在 24 周前停用抗 TNF，2403 例在 24 周后继续使用。继续使用抗 TNF 与降低母亲 IBD 复发的频率（35.8% vs. 39.0%；调整风险比[aRR]，0.93[95%CI，0.86 至 0.99]）和早产（7.6% vs. 8.9%；aRR，0.82[CI，0.68 至 0.99]）有关。继续使用抗 TNF 与死产（0.4% vs. 0.2%；aRR，2.16[CI，0.64 至 7.81]）、小于胎龄儿（13.1% vs. 12.9%；aRR，1.01[CI，0.88 至 1.17]）和儿童严重感染（54.2 比 50.2 每 1000 人年；调整后危害比，1.08[CI，0.94 至 1.25]）无关。
用于识别 IBD 患者、妊娠和严重感染的是算法而不是临床数据。
妊娠 24 周后继续使用抗 TNF 治疗似乎有益于 IBD 活动和早产，而不会影响新生儿结局和儿童严重感染。
无。
