Background

Anti-TNFα is increasingly used as treatment for immune mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA) and psoriasis (PS). However, the impact of anti-TNFα during pregnancy on mother and newborn is under debate. This requires a sound knowledge of the effects of this treatment on pregnancy and neonatal outcomes.

Objectives

To assess pregnancy and neonatal outcomes after anti-TNFα therapy during pregnancy in women with IMID, specifically IBD, RA and PS.

Methods

We performed a systematic review and meta-analysis of 39 studies assessing pregnancy and neonatal outcomes of women with IMID exposed to anti-TNFα agents during pregnancy. We used a random-effects model to determine pooled outcome measures.

Results

An increased risk of preterm births (OR 1.45, 95% CI = 1.16 to 1.82, p = 0.001) and infections in newborns (OR 1.12, 95% CI = 1.00 to 1.27, p = 0.05)) was seen for women in the combined group of IMID exposed to anti-TNFα compared to diseased controls. Specifically for IBD patients exposed to anti-TNFα, the risk was increased for preterm birth (OR 1.66, 95% CI = 1.14 to 2.42, p = 0.009), and low birth weight (OR 1.49, 95% CI = 1.01 to 2.20, p = 0.047) compared to diseased controls. Combined data from studies of women with RA and PS, showed no increased risk for adverse pregnancy outcome after exposure to anti-TNFα. Most children of mothers with IMID received vaccination according to national vaccination schemes and only minor adverse events were reported.

Conclusion

Exposure to anti-TNFα agents during pregnancy is associated with increased risk of preterm birth and infections in newborns of women with IMID compared to diseased controls. The risk of preterm birth and low birth weight was increased in women with IBD specifically. The increased risk of infections in newborns underlines the importance of vaccination, which seems to be safe in children exposed to anti-TNFα. Delay of vaccination is therefore unnecessary in these children. These data may aid in balancing the continuing anti-TNFα therapy versus the risk of adverse pregnancy outcomes.

中文翻译：

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妊娠期暴露于抗肿瘤坏死因子-α的免疫介导炎症性疾病妇女的妊娠和新生儿结局：系统评价和荟萃分析

背景

抗 TNFα 越来越多地用于治疗免疫介导的炎症性疾病 (IMID)，例如炎症性肠病 (IBD)、类风湿性关节炎 (RA) 和银屑病 (PS)。然而，妊娠期抗 TNFα 对母亲和新生儿的影响仍存在争议。这需要充分了解这种治疗对妊娠和新生儿结局的影响。

目标

评估妊娠期 IMID，特别是 IBD、RA 和 PS 女性妊娠期抗 TNFα 治疗后的妊娠和新生儿结局。

方法

我们对 39 项研究进行了系统回顾和荟萃分析，这些研究评估了在妊娠期间暴露于抗 TNFα 药物的 IMID 女性的妊娠和新生儿结局。我们使用随机效应模型来确定汇总结果测量值。

结果

在联合研究中，女性早产（OR 1.45，95% CI = 1.16 至 1.82，p = 0.001）和新生儿感染（OR 1.12，95% CI = 1.00 至 1.27，p = 0.05）的风险增加与患病对照相比，暴露于抗 TNFα 的 IMID 组。特别是对于暴露于抗 TNFα 的 IBD 患者，早产（OR 1.66，95% CI = 1.14 至 2.42，p = 0.009）和低出生体重（OR 1.49，95% CI = 1.01 至 2.20， p = 0.047）与患病对照相比。来自 RA 和 PS 女性研究的综合数据显示，暴露于抗 TNFα 后不良妊娠结局的风险没有增加。大多数患有 IMID 的母亲的孩子根据国家疫苗接种计划接受了疫苗接种，并且仅报告了轻微的不良事件。

结论

与患病对照组相比，在怀孕期间接触抗 TNFα 药物会增加 IMID 女性新生儿早产和感染的风险。特别是 IBD 女性早产和低出生体重的风险增加。新生儿感染风险的增加凸显了疫苗接种的重要性，这对于暴露于抗 TNFα 的儿童似乎是安全的。因此，这些儿童没有必要推迟接种疫苗。这些数据可能有助于平衡持续的抗 TNFα 治疗与不良妊娠结局的风险。