Original articleAlimentary tractPlacental Transfer of Anti–Tumor Necrosis Factor Agents in Pregnant Patients With Inflammatory Bowel Disease
Section snippets
Methods
Pregnant women with Crohn's disease receiving IFX, ADA, or CZP were identified in our practice by referring physicians and through the Crohn's Colitis Foundation of America Pregnancy IBD and Neonatal Outcomes (PIANO) Registry.11 With respect to recruitment from PIANO, patients on anti-TNF agents during pregnancy were identified through the database and the sites were contacted to see if the patients were interested in contributing samples. If they consented to participate, plasma was collected
Results
Thirty-one women were enrolled in the study: 11 exposed to IFX, 10 to ADA, and 10 to CZP. There were 2 sets of twins in the CZP group for a total of 33 infants. Maternal characteristics are noted in Table 1. The median age of the mothers was 32.5 years (range, 22–42 y).
Discussion
In this study of 31 pregnant women with Crohn's disease who gave birth to 33 infants, IFX and ADA showed significant placental transfer as measured by cord blood levels at birth. CZP, however, had only minimal placental transfer to the infant, suggesting passive diffusion rather than active transfer. CZP was not detected in breast milk. In the mothers with sufficient PEG to measure, there were only low levels of free PEG when comparing the total PEG levels with the CZP levels. Because of the
Acknowledgments
The authors give special thanks to Yelena Idomsky and Albina Gitis at the University of California San Francisco; and Dr Y. Beral (Maternity of Calais, France), Dr S. Depret (Maternity J de Flandre, CHRU, Lille, France), and L. Dubuquoy (Inserm U 995, Lille, France).
References (29)
- et al.
Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California
Gastroenterology
(2007) Placental transport of immunoglobulin G
Vaccine
(2003)- et al.
Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial
Lancet
(2002) - et al.
Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial
Gastroenterology
(2006) - et al.
PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy (abstr)
Gastroenterologist
(2012) - et al.
Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn
Clin Gastroenterol Hepatol
(2006) - et al.
Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease
J Crohns Colitis
(2011) - et al.
Adalimumab level in breast milk of a nursing mother
Clin Gastroenterol Hepatol
(2010) - et al.
Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn's disease
J Crohns Colitis
(2010) - et al.
The effect of maternal peripartum infliximab use on neonatal immune response (abstract)
Gastroenterology
(2008)
Disease activity in pregnant women with Crohn's disease and birth outcomes: a regional Danish cohort study
Am J Gastroenterol
The London position statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response?
Am J Gastroenterol
The London position statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics
Am J Gastroenterol
IgG placental transfer in healthy and pathological pregnancies
Clin Dev Immunol
Cited by (387)
Pharmacokinetics of antibodies during Pregnancy: Impact of pregnancy on the pharmacokinetics of antibodies (Part 2)
2023, International ImmunopharmacologySociety for Maternal-Fetal Medicine Consult Series #64: Systemic lupus erythematosus in pregnancy
2023, American Journal of Obstetrics and GynecologySchwangerschaft und Stillzeit bei Morbus Crohn
2024, Aktuelle ErnahrungsmedizinTumour necrosis factor inhibitors and serious infections in reproductive-age women and their offspring: a narrative review
2024, Scandinavian Journal of RheumatologyNon-Infectious Uveitis and Pregnancy, is There an Optimal Treatment? Uveitis Course and Safety of Uveitis Treatment in Pregnancy
2024, Ocular Immunology and InflammationPregnancy and breastfeeding in Crohn's disease
2023, Deutsche Medizinische Wochenschrift
This article has an accompanying continuing medical education activity on page e24. Learning Objectives—At the end of this activity, successful learners will be able to compare placental transfer rates among the 3 anti–tumor necrosis agents used in Crohn’s disease.
Conflicts of interest These authors disclose the following: Uma Mahadevan and David Rubin have served as consultants and received research support from UCB, Janssen, and Abbott; Douglas Wolf, Scott Lee, Corey Siegel, and Thomas Ullman are consultants for Abbott, UCB, and Janssen; Maria Abreu is a consultant for UCB and Abbott; Marla Dubinsky is a consultant for Abbott, UCB, and Janssen, and has received research support from Janssen; Sarah Glover has received research support from UCB; and John Valentine has received research support from UCB, Janssen, and Abbott. The remaining authors disclose no conflicts.
Funding Support was provided by Abbott Labs for the study and performing the assays for adalimumab levels; UCB performed the assays for certolizumab pegol levels; and Prometheus Labs provided research rates to perform the assays for infliximab levels. Dr Mahadevan was supported by a Crohn's Colitis Foundation of America Senior Research Award. None of the sponsors had any input into study design.