Pregnant women with inflammatory bowel disease: the effects of biologicals on pregnancy, outcome of infants, and the developing immune system

ABSTRACT

Introduction: Relapse of inflammatory bowel disease (IBD) during conception and pregnancy has been associated with a negative pregnancy outcome. Therefore, it is advised to maintain drugs in order to prevent relapse. The effect of drugs, which cross the placenta, on children who have been exposed during pregnancy will be discussed in this review.

Areas covered: A literature search was performed using the following search terms: inflammatory bowel disease, pregnancy, infant, antitumor necrosis factor alpha, infliximab, adalimumab, golimumab, certolizumab, anti-integrins, vedolizumab, anti-interleukin (IL)-12/23 ustekinumab, placenta, vaccination. Other studies were identified by using references from articles identified through our original literature search.

The occurrence of unfavorable pregnancy outcome and congenital malformations does not seem to be increased after exposure to anti-TNFα, but the effects on the developing immune system are largely unknown. For anti-integrins and anti IL-12/23, the numbers of exposed pregnancies are too small to draw any conclusions.

Expert commentary: Follow-up of the developing immune system in children exposed to these drugs seems warranted, preferably in a prospective study design.

KEYWORDS:

• Anti-TNFα
• anti-integrins
• anti-interleukin 12/23
• child
• inflammatory bowel disease
• pregnancy outcome

Declaration of interest

J.W. Wieringa and G.J. Driessen have received a research grants from the Dr. C.J.Valliant Foundation. G.J. Driessen has also received research grants from Elizabeth von Freyburg and the Sophia Research Foundation. C.J. van der Woude has served as an advisory board member for MSD, Falk Benelux, Abbott Laboratories, Mundapharma Pharmaceuticals Janssen Takeda and Ferring. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.