P359 Meta-analysis of the effects of anti- tumour necrosis factor alpha therapies on pregnancy outcomes in women with Inflammatory Bowel Disease
Z. Shihab1, N. Yeomans1, P. De Cruz*1, 2, 3
1Austin Health, Office of Research, Melbourne, Australia, 2Austin Health, Department of Gastroenterology, Melbourne, Australia, 3St Vincents Health, Department of Gastroenterology, Melbourne, Australia
Inflammatory Bowel Disease (IBD) commonly affects women in the peak of their reproductive years, leading to patient and physician concerns about the risk of adverse pregnancy outcomes. The aim of this study was to perform a meta-analysis to quantify the risk of adverse pregnancy outcomes in IBD related to maternal exposure to anti-TNFα agents.
Published studies and abstracts were screened from databases (MEDLINE, SCOPUS, EMBASE and Cochrane Reviews) and international meeting abstracts. A meta-analysis using a random-effects model was used to pool estimates and report odd ratios for adverse outcomes, congenital abnormalities, preterm birth and low birth weight. A Chi-Squared analysis of independence was used to compare prevalence of congenital abnormalities pooled from 17 IBD studies compared with 5 pooled population-wide registries.
In women exposed to anti-TNFα the pooled odds ratio (OR) for adverse pregnancy outcomes was: 1.14 (95% CI 0.73 to 1.78; p = 0.555; Figure 1). The pooled ORs for congenital abnormalities, preterm birth and low birth weight were respectively: 0.89 (0.37 to 2.13; p = 0.786), 1.21 (0.74 to 2.00; p = 0.45) and 1.36 (0.77 to 2.38; p = 0.28). The pooled rate of congenital abnormalities from studies in women receiving anti-TNFα treatments was not statistically different from rates of congenital abnormalities pooled from population-wide registries (χ²=1.512, p=0.219; Figure 2). The publication bias and heterogeneity analyses indicated that the studies were comparable with no statistically significant evidence of publication bias.
Figure 2: Comparison of proportions of congenital abnormalities in IBD pregnancies exposed to anti-TNF therapy from published studies with population-wide registries”
Anti-TNFα therapy does not increase the risk of adverse pregnancy outcomes, congenital abnormalities, preterm birth or low birth weight compared with disease-matched controls or the general population. These findings may offer some reassurance for women and physicians regarding the safety profile of anti-TNFα during pregnancy in IBD.