Thématique :
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Nom du veilleur :
Coup de coeur :
The American Journal of Gastroenterology
  2018 Nov;113(11):1669-1677.  
  doi: 10.1038/s41395-018-0176-7.  
  Continuous Anti-TNFα Use Throughout Pregnancy: Possible Complications For the Mother But Not for the Fetus. A Retrospective Cohort on the French National Health Insurance Database (EVASION)  
  Luu M, Benzenine E, Doret M, Michiels C, Barkun A, Degand T, Quantin C, Bardou M  



Inflammatory bowel diseases (IBD) need long-term treatment, which can influence pregnancies in young women. Uncontrolled IBD is associated with poor pregnancy outcomes. Despite the labeling of Anti-tumor necrosis factor (TNF) antibodies (anti-TNFα) which indicates that their use is not recommended during pregnancy, anti-TNFα are increasingly being used during pregnancy and may expose women and their fetuses to treatment-related complications. Existing recommendations on the timing of treatment during pregnancy are inconsistent. We aimed to assess the safety of anti-TNFα treatment in pregnant women with IBD, and up to the first year of life for their children.


An exposed/non exposed retrospective cohort was conducted on the French national health system database SNIIRAM (Système National d'Information Inter-Régimes de l'Assurance Maladie). All IBD women who became pregnant between 2011 and 2014 were included. Women with concomitant diseases potentially treated with anti-TNFα were excluded. Anti-TNFα exposure (infliximab, adalimumab, golimumab or certolizumab pegol) during pregnancy was retrieved from the exhaustive prescription database in SNIIRAM. The main judgment criterion was a composite outcome of disease-, treatment- and pregnancy-related complications during pregnancy for the mother, and infections during the first year of life for children.


We analyzed data from 11,275 pregnancies (8726 women with IBD), among which 1457 (12.9%) pregnancies were exposed to anti-TNFα, mainly infliximab or adalimumab, with 1313/7722 (17.0%) suffering from Crohn's disease and 144/3553 (4.1%) from ulcerative colitis. After adjusting for disease severity, steroid use, age, IBD type, and duration and concomitant 6-mercaptopurine use, anti-TNFα treatment was associated with a higher risk of overall maternal complications (adjusted Odds Ratio (aOR) = 1.49; 95% confidence interval (CI): 1.31-1.67) and infections (aOR = 1.31; 95% CI: 1.16-1.47). Maintaining anti-TNFα after 24 weeks did not increase the risk of maternal complication, but interrupting the anti-TNFα increased relapse risk. No increased risk for infection was found in children (aOR = 0.89; 95% CI: 0.76-1.05) born to mother exposed to anti-TNFα during pregnancy.


Anti-TNFα treatment during pregnancy increased the risk of maternal complications compared to unexposed; however, discontinuation before week 24 increased the risk of disease flare. There was no increased risk for children exposed to anti-TNFα up to 1 year of life.


Question posée
Le maintien d’un traitement par anti-TNF durant la grossesse est-il associé à des complications chez les femmes atteintes de MICI ou chez leur enfant pendant la première année de vie?
Question posée
• Oui le maintien de l’anti-TNF pendant la grossesse est associé à une augmentation de complications chez la mère en particulier infectieuses • Non le maintien de l’anti-TNF n’est pas associé à des complications chez l’enfant exposé in utero • L’arrêt de l’anti-TNF avant la 24e semaine est associé à un risque de poussée de la MICI • Le maintien de l’anti-TNF au-delà de la 24e semaine n’est pas associé à une augmentation des complications

Cette large étude rétrospective française basée sur les données de la SNIIRAM suggère que lorsque l’anti-TNF est indiqué pendant la grossesse, il peut être maintenu au-delà de la 24e semaine sans augmentation de la morbidité.