SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Patrick FAURE
Coup de coeur :
 
 
Gut
  2016/08  
 
  2016 Aug;65(8):1261-8  
  doi: 10.1136/gutjnl-2015-309321  
 
  Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety  
 
  de Lima A, Zelinkova Z, van der Ent C, Steegers EA, van der Woude CJ  
  https://www.ncbi.nlm.nih.gov/pubmed/25966992  
 
 

Abstract

OBJECTIVE:

Antitumour necrosis factor (TNF) during pregnancy in patients with IBD is related to high fetal anti-TNF levels. We evaluated maternal and child safety on discontinuing anti-TNF in the second trimester of pregnancy.

DESIGN:

Two groups of women with IBD were prospectively followed-up during pregnancy: women in sustained remission stopped anti-TNF before week 25 (stop group) and the remaining group continued anti-TNF beyond week 30 (continue group). Maternal, birth and 1-year child outcomes were compared with children of non-IBD women.

RESULTS:

Overall, 106 patients with 83 completed pregnancies were included. Relapse rate after week 22 did not differ between the stop (n=51) and continue (n=32) groups (5 (9.8%) versus 5 (15.6%), p=0.14). There was no difference in allergic reactions (p=1.00) or loss of response (p=1.00) postpartum between the two groups. Birth outcomes were comparable. Infants from both groups had lower birth weight (p=0.001), shorter gestational term (p=0.0001), were more often delivered via caesarean section (p=0.0001) and were less often breastfed (p=0.0001) compared with infants from non-IBD controls. Growth, infection rate, allergies, eczema and adverse reactions to vaccines were comparable across the stop and the continue groups as well as the children of anti-TNF-exposed and non-IBD women at 1 year.

CONCLUSIONS:

To limit anti-TNF exposure in utero, anti-TNF can be stopped safely in the second trimester in women with IBD in sustained remission. In patients not in sustained remission, anti-TNF may be continued without clear additional risks to the fetus. We observed excellent 1-year child outcomes compared with children from non-IBD controls.

 
Question posée
 
Durant la grossesse peut-on poursuivre les anti TNF sans risque pour le fœtus ? Et l’arrêt durant le second semestre chez les patientes en rémission, expose-t-il à un risque ? Deux groupes de patientes ont été suivis durant et après la grossesse pendant 1 an ainsi que le nouveau-né.
 
Question posée
 
Les anti-TNF peuvent être arrêtés en toute sécurité dans le deuxième trimestre chez les femmes souffrant de MICI en rémission durable. Chez les patientes non en rémission soutenue, l’anti-TNF peut être poursuivi sans risque supplémentaire évident pour le fœtus.
 
Commentaires

Ces données rassurantes permettent d’envisager une poursuite des traitements pendant la grossesse et une gestion au cas par cas. 

 
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