Pregnancy and IBD: Biologic risks similar to general population
Adverse pregnancy outcomes among women with inflammatory bowel disease on biologic therapy were comparable to that of the general population, according to study results.
Ole Haagen Nielsen, MD, of the department of gastroenterology at Herlev Hospital in Denmark, and colleagues wrote that most IBD medications are safe to continue during pregnancy, but medication compliance is not universal.
“Patients often misperceive the risks and discontinue treatment before or during pregnancy, as one study revealed that only 60% to 75% of pregnant women complied with their recommended treatment plan,” they wrote. “Therefore, both patients and their providers, including gastroenterologists, obstetrical providers and pediatricians require current evidence-based guidelines to critically appraise the impact and safety of IBD medications during pregnancy in order to empower shared decision making.”
Investigators searched the literature for studies that estimated that prevalence of adverse pregnancy outcomes in IBD when using biologics, including anti-TNF, anti-integrins and anti-cytokines. They identified 48 studies comprising 6,963 patients that fit their criteria.
Researchers found that biologic therapy in pregnant women with IBD was associated with a pooled prevalence of 8% in pregnancy loss (95% CI, 6%-10%), 9% in preterm birth (95% CI, 7%-11%), 0% in still birth (95% CI, 0%-0%), 8% in low birth weight (95% CI, 5%-10%), and 1% in congenital malformations (95% CI, 1%-2%). Their subgroup analysis found that the prevalence of early pregnancy loss and preterm birth were higher among patients who used Entyvio (vedolizumab, Takeda) than those who used anti-TNF.
Additionally, continued anti-TNF use in the third trimester was not associated with risk for preterm birth (RR = 1.41, 95% CI 0.77-2.6), low birth weight (RR = 1.32, 95% CI 0.8-2.18) or congenital malformation (RR = 1.28, 95% 0.47-3.49).
Nielsen and colleagues wrote that their findings showed that the prevalence of adverse pregnancy outcomes in women with IBD is not greater than what is observed in the general population.
“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,” they wrote. “The data presented provides reassurance to patients and providers contemplating discontinuation or avoidance of biologics during pregnancy in women with IBD who are concerned about adverse drug effects on the natural course of pregnancy.”