Vestergaard Thea, Holm Meiltoft Ida, Julsgaard Mette, Bek Helmig Rikke, Friedman Sonia, Kelsen Jens
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Inflamm Bowel Dis. 2024 Dec 5;30(12):2297-2305. doi: 10.1093/ibd/izad316.
Corticosteroids, thiopurines, and biologics may come into play during pregnancy in women with inflammatory bowel disease and potentially impact the developing fetal immune system. We aimed to assess the risk of serious infections in children stratified by in utero exposure to biologics and immunomodulators or concomitant treatment with corticosteroids.
All singleton IBD pregnancies between 2008 and 2022 at a tertiary IBD center in Denmark were included. Maternal and offspring demographics, maternal disease activity, antenatal medical treatment, and infant infections resulting in hospital admission were recorded after review of medical records.
In 602 live births (99.0%), we registered exposure to antenatal treatment as follows: biological monotherapy (n = 61, 10.2%), thiopurines (n = 110, 17.9%), biologics and concomitant thiopurines (n = 63, 10.3%), and controls (ie, no treatment with biological and/or thiopurines; n = 369, 60.6%). Preterm delivery (<37 gestational weeks) and systemic steroid administration during the third trimester were associated with an increased risk of serious infection in the offspring immediately after birth (relative risk = 17.5; 95% confidence interval, 7.8-39.8; P < .001, and relative risk = 4.8; 95% confidence interval, 1.5-12.7; P = 0.003, respectively).Intra-uterine exposure to biologics or combination treatment were not associated with a statistically significant higher risk of serious infections compared with controls; however, combination treatment showed an inclination towards an increased risk across analyses.
Preterm birth and systemic corticosteroid administration late in pregnancy are significant risk factors for serious infections in the offspring of IBD mothers.
在患有炎症性肠病的孕妇孕期，皮质类固醇、硫唑嘌呤和生物制剂可能会发挥作用，并可能影响发育中的胎儿免疫系统。我们旨在评估按宫内接触生物制剂和免疫调节剂或同时使用皮质类固醇进行分层的儿童发生严重感染的风险。
纳入丹麦一家三级炎症性肠病中心2008年至2022年期间所有单胎炎症性肠病孕妇。在查阅病历后，记录孕产妇和后代的人口统计学信息、孕产妇疾病活动情况、产前治疗情况以及导致住院的婴儿感染情况。
在602例活产（99.0%）中，我们记录了产前治疗的暴露情况如下：生物制剂单药治疗（n = 61，10.2%）、硫唑嘌呤（n = 110，17.9%）、生物制剂与硫唑嘌呤联合使用（n = 63，10.3%）以及对照组（即未使用生物制剂和/或硫唑嘌呤治疗；n = 369，60.6%）。早产（<37孕周）和孕晚期全身使用类固醇与出生后立即发生严重感染的风险增加相关（相对风险 = 17.5；95%置信区间，7.8 - 39.8；P <.001，以及相对风险 = 4.8；95%置信区间，1.5 - 12.7；P = 0.003）。与对照组相比，宫内接触生物制剂或联合治疗与严重感染的统计学显著更高风险无关；然而，联合治疗在各项分析中显示出风险增加的倾向。
早产和孕期晚期全身使用皮质类固醇是炎症性肠病母亲后代发生严重感染的重要危险因素。
