Review Article

Common Adverse Effects of Anti-TNF Agents on Gestation

Table 1

Summary of pregnancy outcomes in studies of women with rheumatic diseases exposed to anti-TNF therapy during pregnancy.

RegistryPregnancies exposed (maternal exp.)DiseaseAnti-TNF agent administeredResults

Katz et al. 2004 [17]131 (96 available data)CD, UC, RAINF (96 patients)Live births 64
Miscarriages 14
Theur. Term. 18

Chambers et al. 2004 [18]
OTIS
33RA, CDINF (4 patients)
ETA (29 patients)
Live births ETA: 7 IFX: 2
Miscarriages ETA: 3 IFX: 1
Theur. Term. ETA: 1 IFX: 1
Trisomy 18 ETA: 1

Mahadevan et al. 2005 [19]10CDINF (10 patients)Live births 10
Premature births 3
Low birth weight 1

Joven et al. 2005 [20]14RA, PsA, JIAINF (4 patients)
ETA (8 patients)
ADA (2 patients)
Live births 7
Miscarriages 1
Theur. Term. 4
On-going pregnancies 2

Strangfeld et al. 2007 [21]
RABBIT
37RAINF (2 patients)
ETA (20 patients)
ADA (5 patients)
No relation between the use of anti TNF agents prior to conception and miscarriages, higher congenital malformations, or low birth weight (4.5% versus 6.6%)

Verstappen et al. 2011 [22]
BSRBR
130RA, PsA, JIA, AS, SLE, AOSDINF (30 patients)
ETA (73 patients)
ADA (26 patients)
Live births 88
Theur. Term. 10
Spontaneous abortion was highest among patients exposed to anti-TNF at the time of conception (17% versus 10%)

Schnitzler et al. 2011 [23]42IBDINF (35 patients)
ADA (7 patients)
Live births 32
Low birth weight 6
Premature births 3
On-going pregnancies 1

Clowse et al. 2015 [25]339RA, CDCZP (339 patients)Live births 254
Miscarriages 52
Induced abortion 32
Stillbirth 1

Hoxha et al. 2016 [26]35RA, PsA,
AS
INF (3 patients)
ETA (25 patients)
ADA (5 patients)
CZP (2 patients)
Live births 31
Spontaneous abortion 4
Premature birth 2
Trisomy 16 1
Congenital diaphragmatic hernia and obstructive megaureter 1

Komoto et al. 2016 [27]34IBDINF (33 patients)
ADA (1 patient)
Live births 34
Spontaneous abortion 6
Premature birth 2
Low birth weight 6
Congenital anomaly 1

INF: infliximab; ETA: etanercept; ADA: adalimumab; CZP: certolizumab pegol; Theur. Term.: therapeutic termination; CD: Crohn’s disease; RA: rheumatoid arthritis; PsA: psoriatic arthritis; JIA: juvenile idiopathic arthritis; AS: ankylosing spondylitis; SLE: systemic lupus erythematosus; IBD: inflammatory bowel disease; maternal exp.: maternal exposure.