Infants born to women who were treated with antibodies against tumor necrosis factor alpha (TNF alpha) during pregnancy have detectable levels of antibodies until 12 months of age, according to the results of a recent study, “Concentrations of Adalimumab and Infliximab in Mothers and Newborns, and Effects on Infection,” published in the journal Gastroenterology.
Treatment for inflammatory bowel disease (IBD) relies on antibodies against TNF alpha, such as the drugs adalimumab and infliximab. Pregnant women with IBD are often treated with anti-TNF alpha antibodies to prevent or reduce the chances for premature birth and low birth weight. However, the effects of utero exposure to, and clearance of, anti-TNF alpha agents after birth in newborn children is largely unknown.
A team of international researchers performed a prospective study to investigate the concentrations of adalimumab and infliximab in umbilical cord blood of newborns and rates of clearance after birth. The team also determined how these levels correlated with those in mothers at birth, and how it affected the risk of infection during the first year of life.
The authors analyzed 80 pregnant women with IBD from hospitals in Denmark, Australia, and New Zealand. Thirty-six women received adalimumab, 44 were given infliximab, and 39 received concomitant thiopurines (a class of drugs that are used to suppress the normal activity of the body’s immune system) during pregnancy.
Researchers analyzed medical records on disease activity and treatment before, during, and after pregnancy; and measured the concentration of TNF alpha antibodies in blood samples from women at delivery, in umbilical cords, and in infants every three months until antibodies were no longer detected.
Authors detected antibodies against TNF alpha in newborns until 12 months of age, with adalimumab clearance taking on average 4 months, while infliximab took 7.33 months. Both bacterial and viral infections occurred, but all with benign courses. The viral infections were more prevalent (20 percent) than bacterial (5 percent). Infants whose mothers received combined therapy of anti-TNF and thiopurine had higher risks of developing infections when compared to those who received anti-TNF alone.
“This prospective observational study shows that infant clearance of infliximab after exposure during pregnancy is slower than previously reported,” wrote Mette Julsgaard, MD, PhD, of the department of gastroenterology and hepatology at Aarhus University Hospital in Denmark, and colleagues, according to a news release. “More rapid clearance was seen with adalimumab.”
“Based on these results, we suggest that no live virus vaccine should be given during the first year of life in offspring of women treated with anti-TNF during pregnancy,” researchers concluded. “Pregnant women treated with combination therapy should receive counseling regarding potential risk of postnatal infections in their infant, which should be promptly assessed.”
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