G Broms et al (Clin Gastroenterol Hepatol 2016; 14: 234-41) provide more data on the ‘low risk of birth defects for infants whose mothers are treated with anti-tumor necrosis factor agents during pregnancy.”
From a Danish/Swedish cohort of 1,272,424 live births (2004-2012), the authors found the following (in comparison to healthy infants):
- Birth defects were increased in chronic inflammatory bowel disease: 4.8% vs. 4.2%
- 43 (6.3%) of the infants born to women with IBD who received anti-TNF therapy (683) had birth defects. The OR for any defect was 1.32 (CI 0.93-1.82). The types of defects were generally similar, including VSD, ASD, hypospadias, and hydronephrosis
- In infants of mothers with chronic diseases, it is possible that more careful screening identified some less apparent defects.
- Study did not examine rates of stillborn or abortions
My take: Overall there is a slightly but not significantly increased risk in birth defects based on the use of anti-TNF therapy. Stopping anti-TNF therapy is likely to be more detrimental.
Briefly noted: P Wils et al. Clin Gastroenterol Hepatol 2016; 14: 242-50. This retrospective study of 122 patients showed that 65% had a clinical benefit within 3 months of receiving ustekinumab for Crohn’s disease refractory to anti-TNF therapy. Concomitant immunosuppressant therapy was associated with an increased likelihood of benefit (OR 5.43)
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