RA Treatment During Pregnancy: Is Infection Risk Greater in Offspring?

Results showed that 12.7% of children whose mothers had RA were exposed to TNFis during pregnancy
Results showed that 12.7% of children whose mothers had RA were exposed to TNFis during pregnancy

Children exposed to tumor necrosis factor α inhibitors (TNFi) during the gestational period were found not to have a significantly higher risk of developing serious infections compared with children not exposed to TNFis or children in the general population, according to a study published in Arthritis & Rheumatology

Researchers from McGill University Health Centre, Montreal, Quebec, analyzed US claims data from 2011–2015 to identify 2989 children of women with rheumatoid arthritis (RA) who were matched with 14,596 control children based on maternal age, year of delivery, and state of residence. TNFi exposure was defined as ≥1 filled prescription during pregnancy. Offspring were followed from birth until 12 months, first indication of serious infection, end of commercial insurance eligibility, death or end of study period, whichever came first. 

Results showed that 12.7% of children whose mothers had RA were exposed to TNFis during pregnancy. Serious infections developed in 3.2% of RA offspring with TNFi exposure, 2.0% of RA offspring with no TNFi exposure, and 1.9% among control offspring. When factors such as maternal demographics, co-morbidities, pregnancy complications, and medications were included in the analysis, researchers were still unable to establish a marked excess risk of serious infection in RA children exposed to TNFis compared with RA children with no TNFi exposure (odds ratio [OR] 1.4) or controls (OR 1.7). 

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Lead author, Evelyne Vinet, MD, PhD, added, "Our data are potentially reassuring, however, we could not exclude a differential risk according to specific TNFi characteristics, with infliximab potentially resulting in a 3-fold increase in the risk of serious infections compared with other TNFis." Currently, the European League Against Rheumatism (EULAR) recommends discontinuing infliximab and adalimumab before 20 weeks gestation and etanercept before 31 to 32 weeks gestation to minimize the risk of infections in offspring; certolizumab, however, can be continued throughout pregnancy. 

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