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.

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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.

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Reference

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