The use of biologic therapy before or during pregnancy is not associated with an increased risk for preterm delivery or small-for-gestational-age births in women with autoimmune diseases, according to the results of a population-based cohort study recently published in the Annals of the Rheumatic Diseases.
Women with ≥1 autoimmune disease who were pregnant between 2002 and 2012 were included in the analysis. Exposure to biologics was defined as having ≥1 biologic prescription 3 months before or during pregnancy. Each exposed pregnancy was matched with 5 unexposed pregnancies with the use of high-dimensional propensity scores. The association between biologic use and preterm delivery or small-for-gestational-age births was assessed with the use of logistic regression modeling.
Among 6218 women with 8607 pregnancies who had a diagnosis of an autoimmune disease, 109 women with 120 pregnancies were exposed to biologic therapy 3 months before or during pregnancy. Unadjusted analyses showed that the odds ratio (OR) for the association of exposure to biologics with preterm delivery was 1.64 (95% CI, 1.02-2.63), and the OR for small-for-gestational-age births was 1.34 (95% CI, 0.72-2.51).
After high-dimensional propensity score-matching with 600 unexposed pregnancies, the ORs for the association between biologic exposure and preterm delivery were 1.13 (95% CI, 0.67-1.90), and 0.91 (95% CI, 0.46-1.78) for small-for-gestational-age births.
The investigators concluded that these population-based data do not demonstrate any link between the use of biologic therapy either before or during pregnancy and an increased risk for preterm delivery or small-for-gestational-age births. The study findings suggest that biologics may be a safe treatment option for pregnant women with certain autoimmune diseases who may be at increased risk for adverse pregnancy outcomes.
Tsao NW, Sayre EC, Hanley G, et al. Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study [published online March 1, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213023