Clinicians may be able to avoid the common practice of discontinuing anti–tumor necrosis factor (anti-TNF) treatment after 24 weeks of pregnancy in women with inflammatory bowel diseases (IBDs), a study shows. Continuation of therapy decreased IBD relapse and resulted in higher percentages of women on the therapy at 6 months after pregnancy without affecting neonatal outcomes or serious infections during the first 5 years of the child’s life.
The French national health database was used to identify 5,293 pregnancies during which women were receiving anti-TNF therapy for IBDs. “Continuation of anti-TNF was associated with decreased frequencies of maternal IBD relapse (35.8% vs. 39.0%; adjusted risk ratio [aRR], 0.93 [95% CI, 0.86 to 0.99]) and prematurity (7.6% vs. 8.9%; aRR, 0.82 [CI, 0.68 to 0.99]),” the authors write. “No difference according to anti-TNF continuation was found regarding stillbirths (0.4% vs. 0.2%; aRR, 2.16 [CI, 0.64 to 7.81]), small weight for gestational age births (13.1% vs. 12.9%; aRR, 1.01 [CI, 0.88 to 1.17]), and serious infections in the offspring (54.2 vs. 50.2 per 1000 person-years; adjusted hazard ratio, 1.08 [CI, 0.94 to 1.25]).”
Describing the study’s strong points, the authors write: “First, this study was large enough to detect small differences and rare outcomes, such as stillbirths or serious infection sites. Second, the [database] contains comprehensive outpatient and inpatient information. Third, this study was based on a national, unselected cohort of pregnancies among women with IBD over a recent 11-year period—that is, in the age of widespread use of biologics. All patients were treated within the setting of the French national health system, which provides equal access to health care to French residents. Fourth, we designed an emulation target trial in which maternal, IBD, and pregnancy covariates were used to carefully weight patients in the 2 groups to reduce confounding using a propensity score. Such trials have been recently applied to large health care systems or registries.”