Women with rheumatic diseases who continued to receive tumor necrosis factor inhibitors (TNFi) throughout pregnancy had much lower risks for peri- or postpartum disease flares compared with those who discontinued TNFi, according to a study published in The Journal of Rheumatology.
The study cohort included 40 women and 46 pregnancies. In the first group, 11 patients with 14 pregnancies discontinued TNFi after pregnancy onset. The mean age was 31.9 years. A disease flare complicated 5 of the 14 pregnancies and 2 pregnancies ended in a first-trimester loss. Eight of the 12 remaining pregnant women experienced postpartum disease flares. A total of 78.6% patients in the first group experienced a peri- and/or postpartum flare, and 1 congenital anomaly was reported.
The second group included 29 women who continued TNFi throughout 32 pregnancies that resulted in 34 live births. Mean age was 34 years. A disease flare complicated 3 of the 32 pregnancies (9.4%), and 6 of the 32 (18.7%) experienced postpartum disease flares, with a total of 25% of patients experiencing a peri- and/or postpartum flare. The first group experienced significantly more peri- and postpartum disease flares than the second group (P =.03 and P =.002, respectively), and both groups had a similar birth weight.
Study investigators conclude “that TNFi use throughout pregnancy [did not pose] any specific obstetric or fetal risk in this small cohort. We observed a significantly higher peri- and postpartum flare rate in mothers who discontinued their TNFi during the first trimester. In a patient with chronic inflammatory disease with pre- or periconceptual indications for TNF inhibition, we believe that the maternal benefits of continuing TNFi throughout pregnancy outweigh the remote possibility of adverse pregnancy or fetal outcomes.”
Genest G, Spitzer KA, Laskin CA. Maternal and fetal outcomes in a cohort of patients exposed to tumor necrosis factor inhibitors throughout pregnancy [published online July 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.171152