Original articleBrief communicationEffects of Discontinuing Anti–Tumor Necrosis Factor Therapy During Pregnancy on the Course of Inflammatory Bowel Disease and Neonatal Exposure
Section snippets
Methods
Between April 2006 and April 2011, IBD patients with reproductive wish were recruited through outpatient clinic consultation. The consultation was performed in a standardized manner according to European Crohn's and Colitis Organisation guidelines11 by 2 physicians (Z.Z., C.J.vd.W.). Patients were recruited from the region of Southwest Holland by the physicians affiliated with the Dutch Delta IBD Study Group.
All pregnant patients were followed in a regular bimonthly outpatient clinic. In
Results
From 105 women who received the (pre)conceptional counseling, 31 pregnancies in 28 patients occurred with exposure to anti-TNF (17 to IFX and 11 to ADA). Sixteen patients were on established treatment with IFX; 13 had 5 mg/kg every 8 weeks, 1 patient had 5 mg/kg every 6 weeks, and 1 patient had 10 mg/kg every 8 weeks. One patient started the treatment with IFX because of steroid-resistant disease during pregnancy. All ADA patients were on established treatment before pregnancy; 9 patients used
Discussion
In this study, we evaluated the impact of discontinuation of anti-TNF agents during pregnancy on the course of IBD. We found that discontinuation before gestational week 30 in patients with quiescent disease is feasible and safe in terms of disease control. In addition, this approach helps to reduce the neonatal exposure.
This latter finding needs cautious interpretation. First, IFX can be detected in children for several months after delivery,8 which may interfere with proper response to
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Conflicts of interest These authors disclose the following: Zuzana Zelinkova received consultancy and lecture fees from MSD and a consultancy fee from Abbott. C. Janneke van der Woude received consultancy and lecture fees from MSD and Abbott and a consultancy fee from Shire. The remaining authors disclosed no conflicts.