Anti-Tumour necrosis factor alpha therapies and inflammatory bowel disease pregnancy outcomes: A meta-analysis

Abstract

BACKGROUND AND AIMS:

Inflammatory Bowel Disease (IBD) commonly affects women during their reproductive years leading to concerns regarding pregnancy outcomes and therapeutic safety. The aim of this study was to assess the risks associated with anti-Tumour Necrosis Factor α (anti-TNFα) therapy treatment on pregnancy outcomes including rates of congenital abnormality based on published studies. METHODS:

Published studies were screened from on-line databases and international meeting abstracts. A meta-analysis was performed for adverse pregnancy outcomes (APO), congenital abnormalities (CA), preterm birth (PTB) and low birth weight (LBW). The prevalence of CA was compared with whole population pooled registry data. RESULTS:

In women exposed to anti-TNFα the pooled odds ratio (OR) for APO was 1.14 (95% CI 0.73-1.78; p = 0.55) compared with disease-matched controls. The pooled odds ratios for CA, PTB and LBW were 0.89 (0.37-2.13; p = 0.79), 1.21 (0.74-2.00; p = 0.45) and 1.36 (0.77-2.38; p= 0.29) respectively. The rate of CA in TNFα exposed women was not statistically different from that in population-wide registries (difference 0.4% (95%CI -2.0 - +2.7)). CONCLUSIONS:

Anti-TNFα therapy does not increase the risk of APO, CA, PTB or LBW compared with disease-matched controls. Furthermore, the risk of CA is not increased when published prevalence data are compared to the general population. These findings may offer some reassurance for women and physicians regarding the safety profile of anti-TNFα during pregnancy in IBD