Factors associated with pregnancy outcome in anti-TNF treated women with inflammatory bowel disease

Aliment Pharmacol Ther. 2014 Aug;40(4):363-73. doi: 10.1111/apt.12833. Epub 2014 Jun 30.


Background: The safety of anti-tumour necrosis factor (TNF) agents during pregnancy is a major concern for child-bearing women and physicians.

Aim: To assess the impact of anti-TNF therapy on adverse pregnancy and foetal outcomes in women with inflammatory bowel disease (IBD).

Methods: Pregnancies occurring during anti-TNF treatment or less than 3 months after its cessation in IBD patients followed in GETAID centres were recorded from January 2009 to December 2010. Ninety-nine pregnancies in women without anti-TNF treatment were identified from the CESAME registry. We compared pregnancy and neonatal outcomes by a case-control study.

Results: In the 124 IBD patients followed, 133 pregnancies were reported. At the conception time, 23% of patients had active disease. Eighty-eight per cent (n = 117) of the 133 pregnancies followed until delivery resulted in 118 liveborns (one twin pregnancy). Complications were observed in 47 (35%) women and 24 (20%) newborns. In multivariate analysis, factors associated with pregnancy complications were: current smoking (P = 0.004), a B2 (stenotic) phenotype in CD women (P = 0.004), occurrence of a flare during pregnancy (P = 0.006) and a past history of complicated pregnancy (P = 0.007). Current smoking was the only factor associated with severe (i.e. potentially lethal) pregnancy complications (P = 0.02). Having IBD for more than 10 years prior to conception was associated with newborn complications (P = 0.007). No difference was found with the control group for any of the pregnancy and neonatal outcomes.

Conclusion: In our series, the safety profile of anti-TNF therapy during pregnancy and the neonatal period appears similar to control group of IBD women not treated with anti-TNF therapy.

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Humans
  • Infant, Newborn
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / drug therapy*
  • Multivariate Analysis
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Pregnancy Complications / physiopathology
  • Pregnancy Outcome*
  • Registries
  • Severity of Illness Index
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Time Factors
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


  • Tumor Necrosis Factor-alpha