P644 Influence of anti-tumour necrosis factor-α therapy on pregnancy-related outcomes and immunity of the children in women with inflammatory bowel disease
K. E. Lee*1, S.-A. Jung1, S. H. Park2, C. M. Moon1, S. Y. Shim3, E. S. Kim4, S. J. Cho3, S.-E. Kim1, K. B. Cho4, S.-K. Yang2
1Ewha Woman’s University School of Medicine, Department of Internal Medicine, Seoul, South Korea, 2University of Ulsan College of Medicine, Department of Internal Medicine, Seoul, South Korea, 3Ewha Woman’s University School of Medicine, Department of Paediatrics, Seoul, South Korea, 4Keimyung University School of Medicine, Department of Internal Medicine, Daegu, South Korea
Background
The onset of inflammatory bowel disease (IBD) usually occurs at young age and women experience pregnancy, delivery, and child care during the disease progression, and thus face difficulties continuing medications during the period. Recently, anti-tumour necrosis factor-alpha (anti-TNF-α) has shown effectiveness in refractory IBD, and its use is rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes and immunity of their children in women with IBD who were treated with anti-TNF-α during pregnancy.
Methods
Sixteen women with IBD who had been treated with anti-TNF-α intravenously during pregnancy in Korea were enrolled. Based on medical records and survey, baseline clinical characteristics, disease and drug history, and pregnancy outcome of each patient were investigated. For the 10 patients who agreed on additional examination for their children, growth, development, vaccination history, medical history, and anti-HBs antibody titre were checked.
Results
All patients had Crohn’s disease with no other underlying disease, and their age at delivery was between 25 and 35 years old. During pregnancy, 14 patients used infliximab; 2 used adalimumab; and 2 patients who experienced abortion in the previous pregnancy received combination therapy with azathioprine. There was no preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth in all subjects. Caesarean section was performed in 11 patients. Last anti-TNF-α administration was done between 22 to 32 weeks gestation. The age range of the 10 children investigated in this study was between 8 and 47 months, and the body weight of 2 children was in below the tenth percentile range. All 10 children followed regular vaccination schedule for hepatitis B, and 3 were negative for anti-HBs Ab. Four weeks after the 1 booster vaccination, all children demonstrated seroconversion. Two children had a history of being admitted to the hospital because of upper respiratory infections, and their anti-HBs antibody were negative. Regarding live vaccines, 2 children had BCG vaccine before 1 month of age, and 3 had rotavirus vaccine before 4 months of age, with no specific side effects.
Conclusion
This study was the first study in Korea on patients who gave birth after anti-TNF-α therapy during pregnancy, especially including the children’s immunity. IBD patients had comparable pregnancy outcomes with the general population, even in immunosuppressive combination therapy, suggesting that the disease activity rather than the administered medication would be more important in maintaining healthy pregnancy. From the clinical history of vaccination and anti-HBs titres, immunity including immunological memory seemed to be intact in the children.