Anti-TNF therapy in early pregnancy tied to preeclampsia

“We know that women with inflammatory bowel disease when they are pregnant are at increased risk for adverse pregnancy outcomes,”
Sunanda V. Kane, MD, a gastroenterologist and professor of medicine at Mayo Clinic in Rochester, Minnesota, said at the American College of Gastroenterology Annual Meeting. Control of IBD has been felt to be fundamental for reducing pregnancy risks, and anti-TNF’s in general have been felt to be safe although not approved in pregnancy.

“Preeclampsia is one of those conditions that we believe is more prevalent in the IBD population because of the chronic inflammatory state and it’s interesting that we know that in preeclampsia that there are elevated levels of TNF-alpha.” Dr. Kane said that the research team hypothesized that women who were receiving anti-TNF agents during pregnancy would have a reduced risk for preeclampsia compared with women with IBD who did not receive anti-TNF’s during their pregnancy.

As it turns out, the majority of the nine women receiving anti-TNF stopped therapy during their second trimester and were not exposed in the third trimester when preeclampsia occurs. Since their levels are naturally high early in pregnancy, and the drugs were withdrawn before preeclampsia, perhaps the combination invokes a withdrawal effect. This has implications for the natural genesis of preeclampsia as well.

“I think what’s going to be important is that we look at women who have had true anti-TNF exposure in their third trimester to look to see about this risk for preeclampsia.” She proposed a multi-center trial.

See the original article and exclusive interview video on Healio Gastroenterology here.

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