Exposition to anti-TNF drugs during pregnancy: Outcome of 15 cases and review of the literature

ObjectiveTo report on the outcome of 15 cases of pregnancies in women treated with anti-TNF drugs during conception or pregnancyMethodsFrench rheumatologists connecting to the web-site of CRI site: http://www.cri-net.com were asked to fill in a structured questionnaire reporting the outcome of pregnancy in women still treated by a TNF blocker at the time of conception.ResultsSpondylarthropathies (n = 8), rheumatoid arthritis (n = 4), juvenile idiopathic arthritis (n = 2), and psoriatic arthritis (n = 1) were treated by infliximab (n = 3), adalimumab (n = 2), or etanercept (n = 10). Miscarriages occurred twice, and elective termination was preferred once. Anti-TNF had been administered during the first, second and third trimester of pregnancy in 12, three and two cases. The 12 babies were in good condition, without apparent malformation or symptoms of neonatal illnesses.ConclusionThe number of reported cases exceeds 300, but only 29 women were treated during their whole pregnancy. The rate of congenital malformations observed so far might appear reassuring compared to the general population for women exposed only during conception. Conversely, there are too few reports of exposure during pregnancy to allow any conclusion about the safety of TNF blockers, and additional long term follow-up of children would be welcome in order to rule out minor forms of VACTERL association that might have been overlooked at birth.