title: Anti-Tumour Necrosis Factor α Therapies and Inflammatory Bowel Disease Pregnancy Outcomes: A Meta-analysis.
abstract: OBJECTIVE
  Inflammatory bowel disease (IBD) commonly affects women during their reproductive years, leading to concerns regarding pregnancy outcomes and therapeutic safety. The aim of this study was to assess the risks associated with anti-tumour necrosis factor α (anti-TNFα) therapy for pregnancy outcomes, including rates of congenital abnormality, based on published studies.
  
  
  METHODS
  Published studies were screened from on-line databases and international meeting abstracts. A meta-analysis was performed for adverse pregnancy outcomes (APOs), congenital abnormalities (CAs), preterm birth (PTB) and low birth weight (LBW). The prevalence of CAs was compared with whole-population pooled registry data.
  
  
  RESULTS
  In women exposed to anti-TNFα the pooled odds ratio for APOs was 1.14 (95% confidence interval [CI] 0.73-1.78; p = 0.55) compared with disease-matched controls. The pooled odds ratios for CAs, PTB and LBW were 0.89 (0.37-2.13; p = 0.79), 1.21 (0.74-2.00; p = 0.45) and 1.36 (0.77-2.38; p = 0.29) respectively. The rate of CAs in TNFα-exposed women was not statistically different from that in population-wide registries (difference 0.4%, 95% CI -2.0 to +2.7).
  
  
  CONCLUSIONS
  Anti-TNFα therapy does not increase the risk of APOs, CAs, PTB or LBW compared with disease-matched controls. Furthermore, the risk of CAs is not increased when published prevalence data are compared with data for the general population. These findings may offer some reassurance for women and physicians regarding the safety profile of anti-TNFα during pregnancy in IBD.
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Shihab
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia Office for Research, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Neville D
authors.initials: ND
authors.lastname: Yeomans
authors.affiliation: ppdecruz@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: De Cruz
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000068879:Adalimumab / Q000009:adverse effects* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068582:Certolizumab Pegol / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D015233:Models, Statistical; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000139:chemically induced; D012307:Risk Factors
chemical_list: D000893:Anti-Inflammatory Agents; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
keywords: Biologics; congenital abnormalities; inflammatory bowel disease