RESEARCH - Pregnancy in rheumatology patients exposed to anti-TNF-alpha therapy

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Rheumatology (Oxford). 2006 Dec 7; [Epub ahead of print]

Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor

(TNF)-{alpha} therapy.

Rheumatology Department, University Hospital, Nice, France.

OBJECTIVES: Anti-tumour necrosis factor (TNF)-alpha therapies are considered

category B drugs for pregnancy. Although sometimes prescribed to women of

reproductive age, data in humans are limited with regard to safety for a

developing fetus. The objectives of the present article are to report

experience of anti-TNF-alpha use in pregnancy, and review the international

literature. METHODS: Since 1999 the present authors have used anti-TNF-alpha

(infliximab, etanercept, adalimumab) to treat patients with various chronic

rheumatic conditions. All patients were prospectively followed during their

treatment time and data were systematically collected. RESULTS: In a group

of 442 patients treated with anti-TNF, three women with RA unexpectedly

became pregnant One treated with etanercept chose a therapeutic termination

at two and a half months, despite of any ultrasound anomaly, and

satisfactory fetal growth. The other two patients (one with adalimumab

exposure and one with etanercept exposure) delivered healthy infants. The

following perinatal complications were observed: prematurity, neonatal

jaundice, neonatal urinary Escherichia coli infection and adrenal congenital

hyperplasia of probable hereditary origin.

CONCLUSIONS: To date, there is no evidence that TNF-alpha antagonists are

associated with embryo toxicity, teratogenicity or increased pregnancy loss.

However, caution should be taken when anti-TNF agents are used during

pregnancy, as human experience is still extremely limited, particularly in

patients with rheumatic diseases among whom there are several alarming

reports. The potential risk should be balanced against the known risks

associated with DMARDs and steroid therapy. Large registries will be

necessary before firm conclusions can be drawn.

PMID: 17158212

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17158212

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