BACKGROUND AND PURPOSE:

• Biologics are used to treat inflammatory bowel disease (IBD) and include tumor necrosis factor inhibitors, anti-integrins, and anticytokines
  • These medications are associated with a potential risk for infection, and are known to cross the placenta
• Gubatan et al. (American Journal of Gastroenterology, 2020) sought to evaluate the risk for infantile infections after in utero exposure to biologics used to treat IBD

METHODS:

• Systematic review and meta-analysis
• Data sources
  • PubMed, Embase, Scopus, Web of Science, and CENTRAL from inception to June 2020
• Inclusion criteria
  • Interventional or observational studies
  • Studies that examined infections in infants born to mothers with IBD with or without biologics exposure
• Study design
  • Odds ratios (OR) of outcomes were pooled and analyzed using a random effects model

RESULTS:

• 9 studies | 8,013 women with IBD | 8,490 infants
• Biologic use during pregnancy was not associated with an increased risk for all infantile infections
  • Odds ratio (OR) 0.91 (95% CI, 0.73 to 1.14)
• In subgroup analysis stratified by type of infection, biologic use was associated with increased infantile upper respiratory infections
  • OR 1.57 (95% CI, 1.02 to 2.40)
• Biologic use during pregnancy was not associated with
  • Infantile antibiotic use
    • OR 0.91 (95% CI, 0.73 to 1.14)
  • Infection-related hospitalizations
    • OR 1.33 (95% CI, 0.95 to 1.86)

CONCLUSION:

• The use of biologics during pregnancy in women with IBD is not associated with increased risk for
  • Overall infantile infections
  • Infant antibiotic use
  • Serious infant infections requiring hospitalization
• There is an increased risk for upper respiratory infections with biologic use
  • However, effect appeared to be subtle: infections were self-limited and hospitalization was not required
• The authors hypothesize that the reason infants are not at increased risk for infection include
  • Infant immune status normalizes once drug is cleared
  • Infants may be immunocompromised but receive passive immunity from the mother
  • Pathway blockade that results from biologics may not be important for common infections in infants

Learn More – Primary Sources:

Biologics During Pregnancy in Women With Inflammatory Bowel Disease and Risk of Infantile Infections: A Systematic Review and Meta-Analysis

Related ObG Topics:

Inflammatory Bowel Disease and Biologic Therapies in Pregnancy

Can Tighter Control Improve the Course of Crohn’s Disease?

Is Duloxetine Use During Pregnancy Linked to Adverse Outcomes?