Biologic, thiopurine IBD treatment during pregnancy does not affect maternal, child outcomes

Among pregnant women with inflammatory bowel diseases (IBDs), treatment with thiopurine, biologics, or a combination of both does not seem to worsen maternal or foetal outcomes, a new study has shown.

Conducting a prospective, observational study, the researchers assessed five outcomes across 1,431 live births: congenital malformations, infant infections, preterm births, spontaneous abortions, and low birthweight (LBW). Outcomes were compared between groups according to in utero exposure to biologics and/or thiopurines.

Overall, 133 infants (9 percent) had congenital malformations, 42 (3 percent) were spontaneously aborted, 91 (7 percent) had LBW, and 132 (10 percent) were born preterm. A total of 280 mothers (20 percent) reported at least one pregnancy-related complication.

While women taking biologics or combination therapies had higher rates of caesarean sections than unexposed controls, there were no significant differences in the frequencies of pregnancy complications by drug class. There was also no evidence for a link between drug exposure and congenital malformation.

Cox models further showed that spontaneous abortion was not significantly associated with in utero exposure to biologics (hazard ratio [HR], 1.20, 95 percent confidence interval [CI], 0.50–2.90), thiopurines (HR, 0.96, 95 percent CI, 0.28–3.33), or a combination therapy (HR, 0.96, 95 percent CI, 0.28–3.33).

Similarly, the researchers recorded no significant increase in the occurrence of serious, nonserious, or any infection in the first year of infant life. Use of biologics, thiopurines, or combination therapies during pregnancy did not correlate with the risk of infections. No interactions were reported for the other outcomes as well.

On the other hand, high IBD activity correlated significantly with spontaneous abortion (HR, 3.41, 95 percent CI, 1.51–7.69) and infant infection (odds ratio, 1.73, 95 percent Ci, 1.19–2.51).

“Therapy with these agents can be continued throughout pregnancy in women with IBD to maintain disease control and reduce pregnancy-related adverse events,” the researchers said.