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#Grand Rounds

Use of Biologics in Pregnant Women with IBD: Is there an Increased Risk for Infantile Infections?

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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

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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?

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