title: The Effect of Maternal Peripartum Anti-TNFα Use on Infant Immune Response.
abstract: Infliximab (IFX) and adalimumab (ADA) cross the placenta in the third trimester and can be detectable in infants for up to 12 months.
  
  
  
  The aim of this study was to determine whether in utero IFX or ADA exposure results in an impaired immune response in infants, as measured by immunoglobulin levels and antibody responses to routine primary immunizations.
  
  
  
  Infants who were exposed to in utero anti-TNFα agents were prospectively evaluated. Immunoglobulin levels (IgG, IgM, IgA) and antibodies to standard vaccinations, including tetanus toxoid (tetanus) and Haemophilus influenza type b (Hib), were measured in infants of at least 6 months of age.
  
  
  
  Twelve infants were prospectively studied: 10 exposed to in utero IFX and 2 exposed to ADA with at least one dose administered in the third trimester. Immunoglobulin levels were available on 10/12 patients, with all showing adequate immunoglobulin levels, except for low IgM levels in 5 (50 %) infants. Adequate responses to both the tetanus and Hib vaccines were seen in 11 of 12 (92 %) infants.
  
  
  
  Infants exposed to anti-TNFα agents in utero demonstrate appropriate response to two commonly administered neonatal vaccines and show adequate immunoglobulin levels, except for IgM. Newborns with a history of exposure to anti-TNFα agents should follow a standard vaccination schedule for inactive vaccines.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. sarah.sheibani@usc.edu.|Division of Gastroenterology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 1000, Los Angeles, CA, 90033-5312, USA. sarah.sheibani@usc.edu.
authors.forename: Sarah
authors.identifier: 0000-0002-9067-1128
authors.initials: S
authors.lastname: Sheibani
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sunanda
authors.initials: S
authors.lastname: Kane
authors.affiliation: Division of Gastroenterology, Department of Medicine, Mt. Sinai Medical Center, New York, NY, USA.
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.affiliation: Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Church
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Mahadevan
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018073:Haemophilus Vaccines / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011446:Prospective Studies; D013745:Tetanus Toxoid / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D005765:Gastrointestinal Agents; D018073:Haemophilus Vaccines; D007136:Immunoglobulins; D013745:Tetanus Toxoid; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNFα; Immune response; Inflammatory bowel disease; Pregnancy