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P622 Child outcome in IBD pregnancy: early vs. late discontinuation of IFX therapy

B. Truta*1, T. Bayless1, J. Canner1, S. Bashar1

1Johns Hopkins University, Baltimore, USA

Background

Due to the unknown effect of intra-uterine exposure to biologics, women with IBD discontinue medical therapy early in pregnancy to avoid the risk of foetal exposure. We assessed the child outcome in mothers with IBD, who discontinued Infliximab (IFX) early vs. late during pregnancy.

Methods

We performed a retrospective analysis of all deliveries recorded in the Truven Health Analytics MarketScan® database from 2011 to 2015. We included only those patients on maintenance therapy with (IFX) (they received at least 3 infusions four or more weeks apart). Early discontinuation IFX group (‘Early IFX’) were considered all patients who discontinued IFX 90 days or more prior to delivery; late IFX discontinuation group (‘Late IFX’) were considered all patients who continued IFX closer to the delivery date or throughout the pregnancy. We have linked the mother’s records with the available child records from inpatient and outpatient encounters. Primary outcomes include: congenital malformations, respiratory infection, developmental delay, underweight as defined by ICD-9 codes.

Results

We included 419 mothers with children in our study: 68.4% infants and 31.6% 1 year of age at the end of follow-up. Children of the mothers who discontinued IFX late in pregnancy did not show a different outcome when compared with children from mother who discontinued IFX early in pregnancy (Tables 1 and 2). One patient from the late IFX discontinuation group met the criteria for VACTREL syndrome (cardiac defects, trachea-oesophageal fistula, genitourinary malformations, renal agenesis, hemivertebra).

OutcomesLate infliximab (n = 366)Early infliximab (n = 73)p-Value
Acute respiratory infections, n(%)163 (45.6)27 (37)0.175
Underweight, n(%)49 (13.4)8 (11)0.573
Development delay, n(%)28 (7.6)2 (2.74)0.129
Congenital malformations, n(%)20 (5.5)2 (2.74)0.441

Early IFX and Late IFX group were similar in terms of maternal age at delivery (28.9 ± 4.81 vs. 29.4 ± 5.63, p = NS), parity, gestation, smoking and comorbidities such as HTN, obesity, pulmonary of cardiac diseases. In each Group 2/3 of patients had Crohn’s disease and 1/3 ulcerative colitis. Additional medication use, steroids and/or thiopurine, before discontinuation of IFX was no significant different between the groups. However, mothers who discontinued IFX early in pregnancy were more likely to flare (12.2% vs. 1.33%, p < 0.001)

Conclusion

There was no difference in child outcomes if patients discontinued IFX early or late in pregnancy. These data are reassuring for mothers concerned of negative effect of intra-uterine exposure to IFX therapy.