Gabriella Bröms1, Helle Kieler2, Anders Ekbom3, Mika Gissler4, Karin Hellgren3, Anna-Maria Lahesmaa-Korpinen5, Lars Pedersen6, Marcus Schmitt-Egenolf7, Henrik T Sørensen6, Fredrik Granath3. 1. Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet and Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden. 2. Centre for Pharmacoepidemiology, Department of Medicine Solna and Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. 3. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska institutet, Stockholm, Sweden. 4. Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland and Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 5. Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland. 6. Department of Clinical Epidemiology, Aarhus University, Denmark. 7. Dermatology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Abstract
PURPOSE: To study the risk of preterm birth, caesarean section, and small for gestational age after anti-tumor necrosis factor agent treatment (anti-TNF) in pregnancy. METHODS: Population-based study including women with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, and their infants born 2006 to 2013 from the national health registers in Denmark, Finland, and Sweden. Women treated with anti-TNF were compared with women with nonbiologic systemic treatment. Adalimumab, etanercept, and infliximab were compared pairwise. Continuation of treatment in early pregnancy was compared with discontinuation. Odds ratios with 95% confidence intervals were calculated in logistic regression models adjusted for country and maternal characteristics. RESULTS: Among 1 633 909 births, 1027 infants were to women treated with anti-TNF and 9399 to women with nonbiologic systemic treatment. Compared with non-biologic systemic treatment, women with anti-TNF treatment had a higher risk of preterm birth, odds ratio 1.61 (1.29-2.02) and caesarean section, 1.57 (1.35-1.82). The odds ratio for small for gestational age was 1.36 (0.96-1.92). In pairwise comparisons, infliximab was associated with a higher risk of severely small for gestational age for inflammatory joint and skin diseases but not for inflammatory bowel disease. Discontinuation of anti-TNF had opposite effects on preterm birth for inflammatory bowel disease and inflammatory joint and skin diseases. CONCLUSIONS: Anti-TNF agents were associated with increased risks of preterm birth, caesarean section, and small for gestational age. However, the diverse findings across disease groups may indicate an association related to the underlying disease activity, rather than to agent-specific effects.
PURPOSE: To study the risk of preterm birth, caesarean section, and small for gestational age after anti-tumor necrosis factor agent treatment (anti-TNF) in pregnancy. METHODS: Population-based study including women with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, and their infants born 2006 to 2013 from the national health registers in Denmark, Finland, and Sweden. Women treated with anti-TNF were compared with women with nonbiologic systemic treatment. Adalimumab, etanercept, and infliximab were compared pairwise. Continuation of treatment in early pregnancy was compared with discontinuation. Odds ratios with 95% confidence intervals were calculated in logistic regression models adjusted for country and maternal characteristics. RESULTS: Among 1 633 909 births, 1027 infants were to women treated with anti-TNF and 9399 to women with nonbiologic systemic treatment. Compared with non-biologic systemic treatment, women with anti-TNF treatment had a higher risk of preterm birth, odds ratio 1.61 (1.29-2.02) and caesarean section, 1.57 (1.35-1.82). The odds ratio for small for gestational age was 1.36 (0.96-1.92). In pairwise comparisons, infliximab was associated with a higher risk of severely small for gestational age for inflammatory joint and skin diseases but not for inflammatory bowel disease. Discontinuation of anti-TNF had opposite effects on preterm birth for inflammatory bowel disease and inflammatory joint and skin diseases. CONCLUSIONS: Anti-TNF agents were associated with increased risks of preterm birth, caesarean section, and small for gestational age. However, the diverse findings across disease groups may indicate an association related to the underlying disease activity, rather than to agent-specific effects.
Authors: Hieronymus T W Smeele; Esther Röder; Annemarie G M G J Mulders; Eric A P Steegers; Radboud J E M Dolhain Journal: Ann Rheum Dis Date: 2022-07-11 Impact factor: 27.973
Authors: Laura J O'Byrne; Safi G Alqatari; Gillian M Maher; Aoife M O'Sullivan; Ali S Khashan; Grainne P Murphy; Fergus P McCarthy Journal: BJOG Date: 2022-02-16 Impact factor: 7.331
Authors: Ana-Marija Grišić; Maria Dorn-Rasmussen; Bella Ungar; Jørn Brynskov; Johan F K F Ilvemark; Nils Bolstad; David J Warren; Mark A Ainsworth; Wilhelm Huisinga; Shomron Ben-Horin; Charlotte Kloft; Casper Steenholdt Journal: United European Gastroenterol J Date: 2021-02-11 Impact factor: 4.623