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P492. Impact of anti-TNFa therapy of inflammatory bowel disease during pregnancy on long-term outcome of exposed children

N. Machkova1, D. Duricova1, M. Bortlik1, K. Mitrova2, M. Durilova2, J. Bronsky2, L. Hrdlicka1, M. Lukas1, 1Charles University, IBD Clinical and Research Centre, Iscare, Prague, Czech Republic, 2Charles University, Department of Paediatrics, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic

Background

Anti-TNFa therapy is considered safe during pregnancy. However, data on children born to mothers treated with biologicals are lacking. We aimed to assess the impact of maternal exposure to anti-TNFa preparations on children development and mainly on their immune system.

Methods

Infants over 6months of age born to women with inflammatory bowel disease treated with anti-TNFs during pregnancy at our centre were included. Data on perinatal period, vaccination, mental and physical development, atopy, infections and antibiotic use were obtained from mothers and treating paediatricians using predefined data collection forms and supplied by records from children vaccination cards. Furthermore, standardized laboratory tests on humoral and cellular immunity were performed in a subset of children.

Results

20 children (median follow-up since birth 29 months; range 8–70) were exposed to anti-TNFs in utero (17 infliximab and 3 adalimumab) with a median gestational week of last application being 26 weeks (range 17–35). Of them 17 (85%) were born at term and 3 (15%) preterm with a median birth weight of 2997g (2400–4450). All children had normal growth and all, but one with suspicion on autism, also neuropsychological development. Vaccination was given according to national vaccination protocol to 18 (90%) infants, 2 had their vaccinations postponed. Except for one local reaction with lymphadenopathy after tuberculosis vaccination no other adverse events were seen. One third of children (6) suffer from atopic dermatitis, with 4 having positive history of atopy in parents. 30% (6) and 65% (13) of infants experienced at least 1 infectious complication during the 1st year of life and follow-up period, respectively, with the majority being respiratory. 10 (50%) children have already used at least one course of antibiotic treatment with 5 (25%) during the 1st year of life. Immunological laboratory tests were performed in 7 children revealing borderline low levels of IgG and IgA antibodies in 3 infants, otherwise no significant pathology in serological response to vaccinations or cellular immunity was observed.

Conclusion

Intrauterine exposure to anti-TNFa agents seems to have no significant impact on children during their first 2 and half years of life. The frequency of atopic and infectious complications and need for antibiotic use was comparable to children in our background population.