RESEARCH - Pregnancy in rheumatology patients exposed to anti-TNF therapy

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Rheumatology (Oxford). 2007 Apr;46(4):695-8. Epub 2006 Dec 7.

Pregnancy in rheumatology patients exposed to anti-tumour necrosis

factor (TNF)-alpha therapy.

Roux CH, Brocq O, Breuil V, Albert C, Euller-Ziegler L.

Rheumatology Department, University Hospital, Nice, France.

OBJECTIVES: Anti-tumour necrosis factor (TNF)-alpha therapies are

considered category B drugs for pregnancy. Although sometimes

prescribed to women of reproductive age, data in humans are limited

with regard to safety for a developing fetus. The objectives of the

present article are to report experience of anti-TNF-alpha use in

pregnancy, and review the international literature. METHODS: Since

1999 the present authors have used anti-TNF-alpha (infliximab,

etanercept, adalimumab) to treat patients with various chronic

rheumatic conditions. All patients were prospectively followed during

their treatment time and data were systematically collected. RESULTS:

In a group of 442 patients treated with anti-TNF, three women with RA

unexpectedly became pregnant One treated with etanercept chose a

therapeutic termination at two and a half months, despite of any

ultrasound anomaly, and satisfactory fetal growth. The other two

patients (one with adalimumab exposure and one with etanercept

exposure) delivered healthy infants. The following perinatal

complications were observed: prematurity, neonatal jaundice, neonatal

urinary Escherichia coli infection and adrenal congenital hyperplasia

of probable hereditary origin. CONCLUSIONS: To date, there is no

evidence that TNF-alpha antagonists are associated with embryo

toxicity, teratogenicity or increased pregnancy loss. However, caution

should be taken when anti-TNF agents are used during pregnancy, as

human experience is still extremely limited, particularly in patients

with rheumatic diseases among whom there are several alarming reports.

The potential risk should be balanced against the known risks

associated with DMARDs and steroid therapy. Large registries will be

necessary before firm conclusions can be drawn.

PMID: 17158212

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=ShowDetailView & TermToSear\

ch=17158212

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