Objective: Tumornecrosis factor inhibitors (TNFi) are increasingly used in pregnancy but arefrequently withheld in the second or third trimesters. We evaluated thematernal and fetal outcomes of women who continued their TNFi throughoutpregnancy compared to women who interrupted TNFi during pregnancy.
Methods: Weretrospectively analyzed the outcomes of women seen in clinic with rheumatoidarthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis (JIA), orankylosing spondylitis, who were exposed to TNFi during pregnancy. We separatedpregnancies into 2 groups based on the level of TNFi exposure and comparedoutcomes.
Results InGroup 1 (TNFi exposure in first trimester only), 11 women had 14 pregnanciesand 12 live births. There were 2 first-trimester losses (2/14, 14%), one in thesetting of active RA. Five pregnancies (5/14, 35.7%) were complicated by adisease flare. Eight patients (8/12, 66%) flared postpartum. In Group 2 (TNFiexposure throughout pregnancy), 29 women had 32 pregnancies and 34 live births.Three (3/28, 10.7%) adverse pregnancy outcomes were reported in 2 patients. Onepatient had a twin pregnancy and delivered at 33 weeks after developing pretermpremature rupture of membranes at 32 weeks in the setting of a JIA flare. Hersecond pregnancy was complicated by active JIA before and throughout gestation,and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)syndrome at 39 weeks. Another patient with comorbid antiphospholipid syndromeunderwent a cesarean birth at 36 weeks for suspicion of HELLP syndrome. Six(6/32, 18.7%) postpartum flares occurred.
Conclusion Womenwho discontinued their TNFi during pregnancy had a higher risk of peri- orpostpartum flare compared to those who continued their TNFi throughoutpregnancy.
Geneviève G, et al. Maternal and FetalOutcomes in a Cohort of Patients Exposed to Tumor Necrosis Factor Inhibitorsthroughout Pregnancy. J Rheumatol. 03 July 2018.