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P377. Pregnancy outcome and counselling of anti-TNF-alpha treated IBD women: an ongoing international multicentre study

M. Julsgaard1,4, L.A. Christensen1, I. Lawrence2, R. Gearry3, W. Connell4, A. Grosen1, L. Svenningsen5, J.M. Andrews6, P. Bampton7, A. Walsh8, G.T. Moore9, G. Radford-Smith10, S. Brown4, C.L. Hvas1, J. Kjeldsen11, S.J. Connor12, M.P. Sparrow13, J. Fallingborg14, S.J. Bell4, 1Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark, 2Fremantle Hospital, Centre for Inflammatory Bowel Disease, Fremantle, Australia, 3University of Otago, Christchurch hospital, Dept. of Medicine (Gastroenterology), Christchurch, New Zealand, 4St Vincent's Hospital & University of Melbourne, Gastroenterology, Melbourne, Australia, 5Herning Hospital, Dept. of Medicine (Gastroenterology), Herning, Denmark, 6Royal Adelaide Hospital, University of Adelaide, IBD Service, Dept of Gastroenterology & Hepatology & School of Medicine, Adelaide, Australia, 7Flinders Medical Centre, Gastroenterology and Hepatology, Adelaide, Australia, 8St Vincent's Hospital, Dept. of Gastroenterology, Sydney, Australia, 9Monash University, Monash Health, Dept. of Gastroenterology, Melbourne, Australia, 10Royal Brisbane and Women's Hospital, Gastroenterology, Brisbane, Queensland, Australia, 11Odense University Hospital, Dept. of Gastroenterology and Hepatology, Odense, Denmark, 12Liverpool Hospital & University of NSW, Dept. of Gastroenterology, Sydney, Australia, 13Alfred Hospital and Monash University, Dept. of Gastroenterology, Melbourne, Australia, 14Aalborg Hospital, Department of Gastroenterology, Aalborg, Denmark

Background

IBD is common in the fertile years. With anti-TNF-alpha therapy it has become possible to rapidly induce and maintain remission. This improved therapy makes it possible for women with IBD to consider pregnancy, but concerns regarding the use of drugs during pregnancy are often raised by IBD patients. We examined outcomes of pregnancy among women with IBD exposed to anti-TNF-alpha during pregnancy. Further, medical treatment, disease activity, and counselling were investigated in an international multicentre study.

Methods

115 women exposed to Infliximab (IFX) or Adalimumab (ADA) during pregnancy who had given birth during a 3 year period were identified at 14 hospitals in Denmark, Australia and New Zealand. Electronic questionnaires were used to investigate diagnosis, medical treatment, disease activity, counselling, and birth outcome. Recruitment is ongoing.

Results

86 (74.8%) of the women filled in the questionnaire of whom 3 had a miscarriage prior to gestational week (GW) 10, leaving a study population of 83 women. The pregnancy was planned in 60 (72.3%) of the cases. 54 (65.1%) and 29 (34.9%) received treatment with IFX and ADA, respectively. Co-medication with thiopurines were used in 25 (30.1%) of the pregnancies. 7 (8.4%) gave birth preterm (GW 32–36). None of the babies were small for gestational age or had congenital malformations. Median Apgar score at 5 minutes was 9.3 (range 7–10). Caesarean section was performed in 52 (60.5%) of the deliveries and in 36 (69.2%) of these cases the women stated IBD as the reason. 19 (22.3%) women experienced a relapse during pregnancy of whom 8 (42.1%) had disease activity at delivery. Anti-TNF-alpha therapy was discontinued during the 1st., 2nd. and 3rd. trimester in 3.9%, 38.2% and 57.9% of the cases, respectively. Counselling on medical treatment with anti-TNF-alpha therapy was given to 72 (83.7%) of the women most frequently by a gastroenterologist (88.9%). The vast majority (98.4%) of women were satisfied with the information provided. 75 (87.2%) of the women would accept treatment with anti-TNF-alpha during a future pregnancy.

Conclusion

Maternal anti-TNF-alpha treatment for IBD did not seem to be a risk factor for adverse pregnancy outcomes. Anti-TNF-alpha was discontinued late in pregnancy. The vast majority of women had received counselling by a gastroenterologist on anti-TNF-alpha treatment during pregnancy and were satisfied with the information provided. A third of the pregnancies were unplanned suggesting risk benefit counselling should be offered to all fertile women at initiation of anti-TNF-alpha therapy.