P276. Clinical outcomes of children with prenatal exposure to anti-TNF therapy for maternal inflammatory bowel disease
N.A. Yassin1, T. Tyrrell2, H. Middleton2, M. O'Connor2, N. Arebi2, A.L. Hart3, 1St Mark's Hospital and Academic Institute, Harrow, The Department of Colorectal Surgery, London, United Kingdom, 2IBD Unit, St Mark's Hospital, Harrow, London, United Kingdom, 3IBD Unit, St Mark's Hospital and Academic Institute, Harrow, London, United Kingdom
The use of anti-TNF therapy during conception and pregnancy has been considered to be low risk. The short and long-term effects of anti-TNF therapy used during pregnancy on children are not known. The aim of this study was to assess the clinical outcomes of children who have been exposed to anti-TNF therapy during pregnancy.
A study was performed on retrospectively collected data. Patients who have been pregnant whilst on anti-TNF therapy between 2007 and 2012 were identified from the IBD database and their case notes reviewed. Patients who stopped the anti-TNF treatments prior to conception were excluded.
Twelve pregnancies have been noted in 9 patients. Eight pregnancies continued to term. There was 1 ectopic pregnancy whilst receiving IVF treatment, 1 miscarriage, 1 termination of pregnancy at 15 weeks of gestation due to abdominal cysts, and 1 still pregnant. The background disease was Crohn's disease in 7 patients and indeterminate colitis in 1 patient. Two of the patients were smokers. The median age at the time of pregnancy was 32, with a range of 27–47 years. Six children were exposed to infliximab and 2 to adalimumab during pregnancy. The median duration of intrauterine exposure to biologics was 34.5 weeks with a range of 20–40 weeks. Median follow up was 17.5 months with a range of 1–52 months. All babies were born via caesarean section with a median birth weight of 3245 grams with a range of 2637–4082g. There were no perinatal complications. The majority of children had no congenital malformations. A heart murmur was diagnosed in 1/8 children necessitating surgery. All children had normal growth and neuropsychological development. Vaccinations were given in accordance with the national guidelines in all children. BCG vaccination was not given to 2 children and delayed in another; MMR is yet to be given to 2 children. There were no adverse events associated with the vaccinations. None of the children suffered with atopic dermatitis. There were no reported infectious complications, apart from bronchitis in 1 child.
The results of this study add to the inflammatory bowel disease health care professionals' information on the impact of anti-TNF therapy on children who have been exposed to these medications during pregnancy.