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https://repository.monashhealth.org/monashhealthjspui/handle/1/29311| Title: | Anti-TNF Therapy in Pregnant Women with Inflammatory Bowel Disease: Effects of Therapeutic Strategies on Disease Behavior and Birth Outcomes. | Authors: | Subramaniam K.;Svenningsen L.;Baekdal M.;Kammerlander H.;Walsh A.;Boysen T.;Bampton P.;Radford-Smith G.;Kjeldsen J.;Andrews J.M.;Vestergaard T.;Moore G.T.;Jensen N.M.;Connor S.J.;Wildt S.;Wilson B.;Ellard K.;Christensen L.A.;Bell S.J. ;Julsgaard M.;Hvas C.L.;Gearry R.B.;Gibson P.R.;Fallingborg J.;Sparrow M.P.;Bibby B.M.;Connell W.R.;Brown S.J.;Kamm M.A.;Lawrance I.C. | Monash Health Department(s): | Gastroenterology and Hepatology | Institution: | (Julsgaard, Hvas, Vestergaard, Christensen) Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Entrance C, Aarhus N 8200, Denmark (Julsgaard, Svenningsen) Department of Medicine, Horsens Hospital, Horsens, Denmark (Julsgaard, Connell, Brown, Kamm, Bell) Department of Gastroenterology, St Vincent's Hospital, and University of Melbourne, Melbourne, Australia (Gearry) Department of Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand (Gibson, Sparrow) Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, VIC, Australia (Fallingborg) Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark (Bibby) Department of Biostatistics, University of Aarhus, Aarhus, Denmark (Lawrance) School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute for Medical Research, Murdoch, WA, Australia (Lawrance) Centre for Inflammatory Bowel Diseases, Saint John of God Hospital, Subiaco, WA, Australia (Svenningsen) Department of Medicine, Herning Hospital, Herning, Denmark (Baekdal) Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark (Kammerlander) Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark (Kammerlander, Kjeldsen) Department of Gastroenterology, Odense University Hospital, Odense, Denmark (Walsh) Department of Gastroenterology, St. Vincent's Hospital, Sydney, NSW, Australia (Boysen) Gastrounit, Medical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark (Bampton) Department of Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia (Radford-Smith) Inflammatory Bowel Diseases Unit, Royal Brisbane and Women's Hospital, University of Queensland School of Medicine, Brisbane, QLD, Australia (Andrews) Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia (Subramaniam) Gastroenterology and Hepatology Unit, Canberra Hospital, Australian National University, Canberra, ACT, Australia (Moore, Bell) Department of Gastroenterology, Monash Health, School of Clinical Sciences Monash University, Melbourne, VIC, Australia (Jensen) Abdominalcenter K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Connor) Department of Gastroenterology, Liverpool Hospital, Sydney, University of NSW, Ingham Institute of Applied Medical Research, Sydney, Australia (Wildt) Medical Department, Zealand University Hospital, Koge, Denmark (Wilson) Department of Internal Medicine, Nykobing Falster Hospital, Nykobing, Denmark (Ellard) Mater Hospital, Department of Gastroenterology, Sydney, Australia (Christensen) Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark | Issue Date: | 31-Mar-2020 | Copyright year: | 2020 | Publisher: | Oxford University Press | Place of publication: | United States | Publication information: | Inflammatory Bowel Diseases. 26 (1) (pp 93-102), 2020. Date of Publication: 01 Jan 2020. | Journal: | Inflammatory Bowel Diseases | Abstract: | Background: Active inflammatory bowel disease (IBD) adversely affects pregnancy outcomes. Little is known about the risk of relapse after stopping anti-tumor necrosis factor (anti-TNF) treatment during pregnancy. We assessed the risk of relapse before delivery in women who discontinued anti-TNF treatment before gestational week (GW) 30, predictors of reduced infant birth weight, a marker associated with long-term adverse outcomes, and rates and satisfaction with counseling. Method(s): Pregnant women with IBD receiving anti-TNF treatment were prospectively invited to participate in an electronic questionnaire carried out in 22 hospitals in Denmark, Australia, and New Zealand from 2011 to 2015. Risk estimates were calculated, and birth weight was investigated using t tests and linear regression. Result(s): Of 175 women invited, 153 (87%) responded. In women in remission, the relapse rate did not differ significantly between those who discontinued anti-TNF before GW 30 (1/46, 2%) compared with those who continued treatment (8/74, 11%; relative risk, 0.20; 95% confidence interval [CI], 0.02 to 1.56; P = 0.08). Relapse (P = 0.001) and continuation of anti-TNF therapy after GW 30 (P = 0.007) were independently associated with reduced mean birth weight by 367 g (95% CI, 145 to 589 g; relapse) and 274 g (95% CI, 77 to 471 g; anti-TNF exposure after GW 30). Of 134 (88%) women who received counseling, 116 (87%) were satisfied with the information provided. Conclusion(s): To minimize fetal exposure in women in remission, discontinuation of anti-TNF before GW 30 seems safe. Relapse and continuation of anti-TNF therapy after GW 30 were each independently associated with lower birth weight, although without an increased risk for birth weight <2500 g. Most women received and were satisfied with counseling.Copyright © 2019 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1093/ibd/izz110 | PubMed URL: | 31141607 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31141607] | ISSN: | 1078-0998 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29311 | Type: | Article | Subjects: | budesonide/pv [Special Situation for Pharmacovigilance] infliximab/cb [Drug Combination] infliximab/cm [Drug Comparison] infliximab/dt [Drug Therapy] infliximab/pv [Special Situation for Pharmacovigilance] mercaptopurine/cb [Drug Combination] mercaptopurine/dt [Drug Therapy] mercaptopurine/pv [Special Situation for Pharmacovigilance] mesalazine/pv [Special Situation for Pharmacovigilance] prednisolone/dt [Drug Therapy] prednisolone/pv [Special Situation for Pharmacovigilance] *tumor necrosis factor antibody/cb [Drug Combination] *tumor necrosis factor antibody/dt [Drug Therapy] *tumor necrosis factor antibody/to [Drug Toxicity] *tumor necrosis factor antibody/pv [Special Situation for Pharmacovigilance] mesalazine/dt [Drug Therapy] adult adverse outcome article *attitude to illness Australia cohort analysis controlled study Crohn disease/dt [Drug Therapy] Denmark *disease activity female fetus gestational age human *inflammatory bowel disease/dt [Drug Therapy] low birth weight major clinical study male medical information New Zealand newborn *patient counseling *patient satisfaction prediction *pregnancy outcome pregnant woman priority journal prospective study questionnaire *recurrence risk risk assessment third trimester pregnancy *treatment response ulcerative colitis/dt [Drug Therapy] adalimumab/cb [Drug Combination] adalimumab/cm [Drug Comparison] adalimumab/dt [Drug Therapy] adalimumab/pv [Special Situation for Pharmacovigilance] allopurinol/cb [Drug Combination] allopurinol/dt [Drug Therapy] allopurinol/pv [Special Situation for Pharmacovigilance] budesonide/dt [Drug Therapy] budesonide infliximab mercaptopurine mesalazine prednisolone tumor necrosis factor antibody adverse outcome attitude to illness Australia Crohn disease Denmark disease activity fetus gestational age inflammatory bowel disease low birth weight medical information New Zealand newborn patient counseling pregnancy outcome pregnant woman recurrence risk third trimester pregnancy ulcerative colitis adalimumab allopurinol budesonide female fetus gestational age human *inflammatory bowel disease / *drug therapy low birth weight major clinical study male medical information New Zealand newborn *patient counseling *patient satisfaction prediction *pregnancy outcome pregnant woman priority journal prospective study questionnaire *recurrence risk risk assessment adverse outcome *treatment response ulcerative colitis / drug therapy adult third trimester pregnancy Article *attitude to illness Australia cohort analysis controlled study Crohn disease / drug therapy Denmark *disease activity |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
| Appears in Collections: | Articles |
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