Prevalence and relative risk (RR) were pooled using a random effects model
Authors assessed impact of disease activity and stratifying by type of biologic administered when possible
48 studies | 6,963 patients
Biologic therapy in IBD pregnancies was associated with the following pooled prevalences
Early pregnancy loss: 8% (95% CI, 6 to 10%)
Preterm birth: 9% (95% CI, 7 to 11%)
Still birth: 0% (95% CI, 0 to 0%)
Low birth weight: 8% (95% CI, 5 to 10%)
Congenital malformations: 1% (95% CI, 1 to 2%)
Overall, above prevalence rates comparable to general populations
In subgroup analyses of a small number of studies, the prevalence of early pregnancy loss and preterm birth were higher in vedolizumab (an anti-integrin) vs anti-TNF users
Continued TNF inhibitor use during the third trimester was not associated with risk for the following
Preterm birth: RR 1.41 (95% CI, 0.77 to 2.60)
Low birth weight: RR 1.32 (95% CI, 0.80 to 2.18)
Congenital malformations: RR 1.28 (95% CI, 0.47 to 3.49)
Women with IBD who use biologics during pregnancy experience adverse pregnancy outcomes similar to the general population
Results included no evidence of increased prevalence for early pregnancy loss or stillbirth rates which were comparable to those seen in women with IBD and the general population
The authors conclude that
…prevalence of adverse pregnancy outcomes in pregnant women with
IBD exposed to TNF inhibitors is not greater than the general population while larger studies are needed to better evaluate the newest biologics, vedolizumab and ustekinumab
Our data also suggests that continued biologic therapy throughout the third trimester of pregnancy is not associated with increased risk of adverse pregnancy outcomes as compared to discontinuing biologics earlier on
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