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DOP040. Anti-TNF-α therapies are safe during pregnancy in patients with inflammatory bowel disease: a meta-analysis

N. Narula1, R. Al-Dabbagh1, A. Dhillon2, J. Marshall1, 1McMaster University, Gastroenterology, Hamilton, Canada, 2Northern Ontario School of Medicine, Internal Medicine, Sudbury, Canada

Background

The use of anti-TNF-α agents is well described for inflammatory bowel disease (IBD), but their safety profile during pregnancy is yet to be fully elucidated. A systematic review and meta-analysis were performed to identify studies that explored the safety of anti-TNF-α therapy during pregnancy in patients with IBD.

Methods

A systematic literature search was conducted to identify studies that investigated the pregnancy outcomes among women with IBD on anti-TNF-α therapy. The primary outcome was the overall rate of unfavourable pregnancy-related outcomes among women with IBD on anti-TNF-α therapy. Secondary outcomes included rates of abortions (spontaneous or elective), preterm delivery, low birth weight, and congenital malformations. Odds ratios (OR) with 95% CI are reported. Studies included met the following criteria: observational or treatment design; had subjects with IBD on anti-TNF-α therapy for at least one trimester; and comparison with appropriately matched controls.

Results

Overall, five studies with a total of 1216 participants were eligible for inclusion in the meta-analysis. There was no significant difference in the rates of total unfavourable pregnancy outcomes between pregnant women with IBD who were on anti-TNF-α therapy compared to controls not on anti-TNF-α therapy (OR 1.12, 95% CI 0.79–1.59) (Figure 1).

Similarly, there were no statistically significant differences in the rates of abortion (OR 1.48, 95% CI 0.93–2.35), preterm birth (OR 1.00, 95% CI 0.62–1.62), low birth weight (OR 1.05, 95% CI 0.62–1.78), or congenital malformation (OR 1.10, 95% CI 0.58–2.09) (Figure 2).

Figure 1.

Figure 2.

Conclusion

The use of anti-TNF-α therapy does not appear to increase the risk of unfavourable pregnancy outcomes among women with IBD, although the optimal timing of therapy through pregnancy and the post-partum period was not assessed in this analysis. This data can help counsel patients around family planning and perinatal management.