Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease

Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes

Mette Julsgaard*, Christian L Hvas, Richard B Gearry, Peter R Gibson, Jan Fallingborg, Miles P Sparrow, Bo M Bibby, William R Connell, Steven J Brown, Michael A Kamm, Ian C Lawrance, Thea Vestergaard, Lise Svenningsen, Mille Baekdal, Heidi Kammerlander, Alissa Walsh, Trine Boysen, Peter Bampton, Graham Radford-Smith, Jens Kjeldsen & 10 others Jane M Andrews, Kavitha Subramaniam, Gregory T Moore, Nanna M Jensen, Susan J Connor, Signe Wildt, Benedicte Wilson, Kathrine Ellard, Lisbet A Christensen, Sally J Bell

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
JournalInflammatory Bowel Diseases
Volume26
Issue number1
Pages (from-to)93-102
ISSN1078-0998
DOIs
Publication statusPublished - 1. Jan 2020

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Therapeutic Uses
Inflammatory Bowel Diseases
Pregnant Women
Tumor Necrosis Factor-alpha
Counseling
Confidence Intervals
Denmark
New Zealand
Linear Models

Cite this

Julsgaard, M., Hvas, C. L., Gearry, R. B., Gibson, P. R., Fallingborg, J., Sparrow, M. P., ... Bell, S. J. (2020). Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease: Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes. Inflammatory Bowel Diseases, 26(1), 93-102. https://doi.org/10.1093/ibd/izz110
Julsgaard, Mette ; Hvas, Christian L ; Gearry, Richard B ; Gibson, Peter R ; Fallingborg, Jan ; Sparrow, Miles P ; Bibby, Bo M ; Connell, William R ; Brown, Steven J ; Kamm, Michael A ; Lawrance, Ian C ; Vestergaard, Thea ; Svenningsen, Lise ; Baekdal, Mille ; Kammerlander, Heidi ; Walsh, Alissa ; Boysen, Trine ; Bampton, Peter ; Radford-Smith, Graham ; Kjeldsen, Jens ; Andrews, Jane M ; Subramaniam, Kavitha ; Moore, Gregory T ; Jensen, Nanna M ; Connor, Susan J ; Wildt, Signe ; Wilson, Benedicte ; Ellard, Kathrine ; Christensen, Lisbet A ; Bell, Sally J. / Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease : Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes. In: Inflammatory Bowel Diseases. 2020 ; Vol. 26, No. 1. pp. 93-102.
@article{bd6a3c6ae83544dfb40e1b569aea2b16,
title = "Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease: Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes",
abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.",
author = "Mette Julsgaard and Hvas, {Christian L} and Gearry, {Richard B} and Gibson, {Peter R} and Jan Fallingborg and Sparrow, {Miles P} and Bibby, {Bo M} and Connell, {William R} and Brown, {Steven J} and Kamm, {Michael A} and Lawrance, {Ian C} and Thea Vestergaard and Lise Svenningsen and Mille Baekdal and Heidi Kammerlander and Alissa Walsh and Trine Boysen and Peter Bampton and Graham Radford-Smith and Jens Kjeldsen and Andrews, {Jane M} and Kavitha Subramaniam and Moore, {Gregory T} and Jensen, {Nanna M} and Connor, {Susan J} and Signe Wildt and Benedicte Wilson and Kathrine Ellard and Christensen, {Lisbet A} and Bell, {Sally J}",
note = "{\circledC} 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.",
year = "2020",
month = "1",
day = "1",
doi = "10.1093/ibd/izz110",
language = "English",
volume = "26",
pages = "93--102",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "Lippincott Williams & Wilkins",
number = "1",

}

Julsgaard, M, Hvas, CL, Gearry, RB, Gibson, PR, Fallingborg, J, Sparrow, MP, Bibby, BM, Connell, WR, Brown, SJ, Kamm, MA, Lawrance, IC, Vestergaard, T, Svenningsen, L, Baekdal, M, Kammerlander, H, Walsh, A, Boysen, T, Bampton, P, Radford-Smith, G, Kjeldsen, J, Andrews, JM, Subramaniam, K, Moore, GT, Jensen, NM, Connor, SJ, Wildt, S, Wilson, B, Ellard, K, Christensen, LA & Bell, SJ 2020, 'Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease: Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes', Inflammatory Bowel Diseases, vol. 26, no. 1, pp. 93-102. https://doi.org/10.1093/ibd/izz110

Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease : Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes. / Julsgaard, Mette; Hvas, Christian L; Gearry, Richard B; Gibson, Peter R; Fallingborg, Jan; Sparrow, Miles P; Bibby, Bo M; Connell, William R; Brown, Steven J; Kamm, Michael A; Lawrance, Ian C; Vestergaard, Thea; Svenningsen, Lise; Baekdal, Mille; Kammerlander, Heidi; Walsh, Alissa; Boysen, Trine; Bampton, Peter; Radford-Smith, Graham; Kjeldsen, Jens; Andrews, Jane M; Subramaniam, Kavitha; Moore, Gregory T; Jensen, Nanna M; Connor, Susan J; Wildt, Signe; Wilson, Benedicte; Ellard, Kathrine; Christensen, Lisbet A; Bell, Sally J.

In: Inflammatory Bowel Diseases, Vol. 26, No. 1, 01.01.2020, p. 93-102.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Anti-TNF Therapy in Pregnant Women With Inflammatory Bowel Disease

T2 - Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes

AU - Julsgaard, Mette

AU - Hvas, Christian L

AU - Gearry, Richard B

AU - Gibson, Peter R

AU - Fallingborg, Jan

AU - Sparrow, Miles P

AU - Bibby, Bo M

AU - Connell, William R

AU - Brown, Steven J

AU - Kamm, Michael A

AU - Lawrance, Ian C

AU - Vestergaard, Thea

AU - Svenningsen, Lise

AU - Baekdal, Mille

AU - Kammerlander, Heidi

AU - Walsh, Alissa

AU - Boysen, Trine

AU - Bampton, Peter

AU - Radford-Smith, Graham

AU - Kjeldsen, Jens

AU - Andrews, Jane M

AU - Subramaniam, Kavitha

AU - Moore, Gregory T

AU - Jensen, Nanna M

AU - Connor, Susan J

AU - Wildt, Signe

AU - Wilson, Benedicte

AU - Ellard, Kathrine

AU - Christensen, Lisbet A

AU - Bell, Sally J

N1 - © 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

U2 - 10.1093/ibd/izz110

DO - 10.1093/ibd/izz110

M3 - Journal article

VL - 26

SP - 93

EP - 102

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 1

ER -