Anti-TNF levels in cord blood at birth are associated with anti-TNF type.
J Crohns Colitis. 2018 May 15;:
Authors: Kanis SL, de Lima A, van der Ent C, Rizopoulos D, van der Woude CJ
Background and Aims: Pregnancy guidelines for women with Inflammatory Bowel Disease (IBD) provide recommendations regarding anti-TNF cessation during pregnancy, in order to limit fetal exposure. Although infliximab (IFX) leads to higher anti-TNF concentrations in cord blood than adalimumab (ADA), recommendations are similar. We aimed to demonstrate the effect of anti-TNF cessation during pregnancy on fetal exposure, for IFX and ADA separately.
Methods: We conducted a prospective single center cohort study. Women with IBD, using IFX or ADA, were followed-up during pregnancy. In case of sustained disease remission, anti-TNF was stopped in the third trimester. At birth, anti-TNF concentration was measured in cord blood. A linear regression model was developed to demonstrate anti-TNF concentration in cord blood at birth. In addition, outcomes such as disease activity, pregnancy outcomes and 1-year health outcomes of infants were collected.
Results: We included 131 pregnancies that resulted in a live birth (73 IFX, 58 ADA). At birth, 94 cord blood samples were obtained (52 IFX, 42 ADA), showing significantly higher levels of IFX than ADA (p<0.0001). Anti-TNF type and stop week were used in the linear regression model. During the third trimester, IFX transportation over the placenta increases exponentially, however, ADA transportation is limited and increases in a linear fashion. Overall, health outcomes were comparable.
Conclusions: Our linear regression model shows that ADA may be continued longer during pregnancy as transportation over the placenta is lower than IFX. This may reduce relapse risk of the mother without increasing fetal anti-TNF exposure.
PMID: 29771301 [PubMed – as supplied by publisher]