Biologic use in pregnancy not associated with adverse birth outcomes
medwireNews: Women with autoimmune diseases who use biologics 3 months before or during pregnancy are not at increased risk for preterm delivery or having small-for-gestational age (SGA) babies, according to a population-based study.
In a matched cohort of women with autoimmune diseases (mostly rheumatoid arthritis or inflammatory bowel disease), 18% of 120 babies whose mothers were exposed to biologics preconception or during pregnancy were born preterm, compared with 16% of 600 babies whose mothers were unexposed to biologics. The mean gestational age at delivery was 38 weeks in both groups.
SGA births were seen in 9% of pregnancies in the group exposed to biologics and 10% of those without such exposure. Apgar scores were similar between the two groups, with mean Apgar scores of 8.1 at 1 minute and 9.0 at 5 minutes in the biologic-exposed group, compared with scores of 7.7 and 8.7, respectively, in the unexposed group.
Crude and adjusted logistic regression analyses failed to find an association between biologic exposure and preterm delivery or SGA, with adjusted nonsignificant ORs of 1.13 and 0.91, respectively.
These results, say Mary De Vera (University of British Columbia, Vancouver, Canada) and colleagues, “suggest that biologics may be a safe treatment option for women with certain autoimmune diseases who, as previous research suggest[s], are at higher risk of adverse pregnancy outcomes due to their disease.”
The study, which is reported in the Annals of the Rheumatic Diseases, drew on population-based administrative data from British Columbia to identify women with at least one autoimmune disease that could be treated with a biologic and who had one or more pregnancies between 2002 and 2012, giving a population of 6218 women with 8607 pregnancies. The researchers then used high-dimensional propensity scores to match women with a biologic prescription 3 months before or during pregnancy with five unexposed pregnancies.
Although all biologics were assessed, the tumor necrosis factor-α inhibitors infliximab, etanercept, and adalimumab accounted for 94% of the biologics used in this study and the results are therefore less applicable to other biologic agents, say the researchers.
Nonetheless, “[this] study represents an important contribution to the accumulation of evidence on the safety of the use of biologics in pregnant women, which may lead to increased prescriber comfort and patient acceptance, decreased uncertainty and improved maternal and neonatal outcomes in this population,” they conclude.
By Catherine Booth
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