P580. Biologic therapy in pregnancy and inflammatory bowel disease: a prospective 7 year study: clinical outcome
F. Habal1, 1University Health Network, Medicine, Toronto, Ontario, Canada
The long term effect of biologics in pregnant women with IBD is not known.
We prospectively followed women who planned pregnancies over the course of 7 years.
There were 29 pregnancies in 21 women with inflammatory bowel disease (IBD). There were 4 ulcerative colitis patients and 17 Crohn's disease.
Three patients received Biologics during the first trimester in view of failure to respond to other medications. All other patients have been on biologics prior to conception and throughout their pregnancies and were in remission at the time of conception. The mean duration of biologic therapy was 18.5±14 months. Twenty pregnancies were on Infliximab at a dose of 5 mg /kg, and the other 7 were receiving a maintenance dose of Adalimumab every second week at 40 mg subcutaneously (SC). Six patients were on Azathioprine at a dose of 2m/kg. The mean age was 23±5.95, with mean disease duration of 6±3.18 years. With the exception of two patients who continued their biologics until delivery, the biologics were discontinued at 32 weeks of gestation.
Two patients had a mild flare up in their disease and received 15 mg of prednisone which were tapered over a four week period.
There were two spontaneous abortions. These occurred during the first trimester. These patients have had previous abortions while not receiving biologics. Chromosomal analysis revealed abnormal chromosomes in previous pregnancies off of any biologics.
There were 27 infants born at full term. The mean gestation was 38.3±1.1 (range 37–40) weeks. The mean birth weight was 3250 gm±213 and the Apgar score at birth was 8.4±1. There were two mild relapses occurring at 12 weeks and at 18 weeks. Both responded to low dose steroids. The rest of the patients were maintained in remission. There were no congenital anomalies detected in any of the newborn. All patients remained in remission after 32 weeks gestation while off their biologic therapy.
Biologic therapy with Infliximab and Adalimumab appears to be safe and effective in maintaining remission in pregnant women with IBD. Although this is a small cohort, there was no evidence of congenital anomalies.