Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13205-13211
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13205
Safety of anti-tumor necrosis factor therapy during pregnancy in patients with inflammatory bowel disease
Ioannis Androulakis, Christos Zavos, Panagiotis Christopoulos, George Mastorakos, Maria Gazouli
Ioannis Androulakis, Panagiotis Christopoulos, George Mastorakos, Endocrine Unit, Aretaieion Hospital, University of Athens Medical School, 11527 Athens, Greece
Christos Zavos, Maria Gazouli, Department of Basic Biological Sciences, Laboratory of Biology, School of Medicine, University of Athens, 11527 Athens, Greece
Author contributions: Androulakis I, Christopoulos P and Gazouli M wrote the paper; Zavos C and Mastorakos G performed the critical review and edited the manuscript.
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Gazouli, Assist Professor, Department of Basic Biological Sciences, Laboratory of Biology, School of Medicine, University of Athens, Michalakopoulou 176, 11527 Athens, Greece. mgazouli@med.uoa.gr
Telephone: +30-210-7462231 Fax: +30-210-7462231
Received: July 7, 2015
Peer-review started: July 8, 2015
First decision: July 20, 2015
Revised: July 24, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 21, 2015
Processing time: 160 Days and 17.1 Hours
Abstract

Treatment of inflammatory bowel disease has significantly improved since the introduction of biological agents, such as infliximab, adalimumab, certolizumab pegol, and golimumab. The Food and Drug Administration has classified these factors in category B, which means that they do not demonstrate a fetal risk. However, during pregnancy fetuses are exposed to high anti-tumor necrosis factor (TNF) levels that are measurable in their plasma after birth. Since antibodies can transfer through the placenta at the end of the second and during the third trimesters, it is important to know the safety profile of these drugs, particularly for the fetus, and whether maintaining relapse of the disease compensates for the potential risks of fetal exposure. The limited data available for the anti-TNF drugs to date have not demonstrated any significant adverse outcomes in the pregnant women who continued their therapy from conception to the first trimester of gestation. However, data suggest that anti-TNFs should be discontinued during the third trimester, as they may affect the immunological system of the newborn baby. Each decision should be individualized, based on the distinct characteristics of the patient and her disease. Considering all the above, there is a need for more clinical studies regarding the effect of anti-TNF therapeutic agents on pregnancy outcomes.

Keywords: Anti-tumor necrosis factor; Pregnancy; Adverse effects; Crohn’s disease; Ulcerative colitis; Inflammatory bowel disease

Core tip: Modern inflammatory bowel disease treatment includes biological therapy, such as anti-tumor necrosis factor (TNF) agents. There are concerns over the use of anti-TNF agents during pregnancy, although the data available to date are limited. No significant increases in the adverse outcomes of pregnancy have been reported in women who continued their treatment from conception to the first trimester of pregnancy. Decision making in this case dictates that the mother’s benefits of maintaining relapse of the disease through continuation of anti-TNFs exceeds the potential risks of fetal exposure.