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A 10-year emulation trial of pregnant persons with inflammatory bowel disease (IBD) has found that continuation of anti–tumor necrosis factor (anti-TNF) treatment after 24 weeks of pregnancy appears beneficial regarding IBD activity and prematurity, while not affecting neonatal outcomes and serious infections in the offspring. The findings are published in Annals of Internal Medicine.
More than six million people in both North America and Europe live with the inflammatory bowel diseases Crohn’s disease (CD) and ulcerative colitis (UC). Many affected persons include women of childbearing age, who are at higher risk of increased rates of prematurity, low birthweight, and cesarean section during pregnancy and birth. Anti-TNF is commonly prescribed during pregnancy, but European guidelines advise to consider stopping anti-TNF treatment around 24 weeks of pregnancy in patients with sustained IBD remission.
Researchers from EPI-PHARE conducted a nationwide target trial emulation of 5,293 pregnancies. Anti-TNF treatment was discontinued before 24 weeks for 2,890 participants and continued beyond 24 weeks for 2,403. The authors found that continuation of anti-TNF was associated with decreased frequencies of maternal IBD relapse and prematurity. The authors also report no difference between groups concerning stillbirths, small weight for gestational age births, or serious infection in offspring. They note that discontinuation of anti-TNF treatment was associated with increased IBD activity and consequently with an increased rate of preterm birth. According to the authors, these results provide strong evidence supporting the recommendation of maintaining anti-TNF throughout pregnancy in women with IBD.