Maternal and Fetal Outcomes in a Cohort of Patients Exposed to Tumor Necrosis Factor Inhibitors throughout Pregnancy
Maternal and Fetal Outcomes in a Cohort of Patients Exposed to Tumor Necrosis Factor Inhibitors throughout Pregnancy
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DOI：
10.3899/jrheum.171152
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发表时间：
2018-08-01
影响因子：
3.9
通讯作者：
Laskin, Carl A.
中科院分区：
文献类型：
--
作者：
Genest, Genevieve;Spitzer, Karen A.;Laskin, Carl A.
客观的。肿瘤坏死因子抑制剂 (TNFi) 在妊娠期的使用越来越多，但在妊娠中期或晚期经常被停用。我们评估了在整个怀孕期间继续使用 TNFi 的女性与在怀孕期间中断 TNFi 的女性的母婴结局。方法。我们回顾性分析了临床上患有类风湿性关节炎 (RA)、银屑病关节炎、幼年特发性关节炎 (JIA) 或强直性脊柱炎、在怀孕期间暴露于 TNFi 的女性的结果。我们根据 TNFi 暴露水平将妊娠分为 2 组并比较结果。结果。在第 1 组（仅在妊娠前三个月接触 TNFi）中，11 名女性怀孕 14 次，产下 12 名活产婴儿。有 2 例妊娠早期流产 (2/14, 14%)，其中 1 例是由于活动性 RA 引起的。有 5 次怀孕（5/14，35.7%）因疾病发作而复杂化。八名患者 (8/12, 66%) 产后病情加重。在第 2 组（整个怀孕期间暴露于 TNFi）中，29 名女性怀孕 32 次，产下 34 名活产婴儿。 2 名患者报告了 3 次（3/28，10.7%）不良妊娠结局。一名患者怀有双胞胎，并在第 32 周因幼年特发性关节炎发作而出现胎膜早破后，于第 33 周分娩。她第二次怀孕时出现了妊娠前和整个妊娠期间的活动性幼年特发性关节炎，以及第 39 周时的溶血、肝酶水平升高和低血小板水平 (HELLP) 综合征。另一名患有抗磷脂综合征的患者因怀疑患有 HELLP 综合征，在 36 周时接受了剖腹产。六例（6/32，18.7%）产后发作。结论。与在整个怀孕期间继续使用 TNFi 的女性相比，在怀孕期间停止使用 TNFi 的女性发生围产期或产后复发的风险更高。
Objective. Tumor necrosis factor inhibitors (TNFi) are increasingly used in pregnancy but are frequently withheld in the second or third trimesters. We evaluated the maternal and fetal outcomes of women who continued their TNFi throughout pregnancy compared to women who interrupted TNFi during pregnancy.Methods. We retrospectively analyzed the outcomes of women seen in clinic with rheumatoid arthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis (JIA), or ankylosing spondylitis, who were exposed to TNFi during pregnancy. We separated pregnancies into 2 groups based on the level of TNFi exposure and compared outcomes.Results. In Group 1 (TNFi exposure in first trimester only), 11 women had 14 pregnancies and 12 live births. There were 2 first-trimester losses (2/14, 14%), one in the setting of active RA. Five pregnancies (5/14, 35.7%) were complicated by a disease flare. Eight patients (8/12, 66%) flared postpartum. In Group 2 (TNFi exposure throughout pregnancy), 29 women had 32 pregnancies and 34 live births. Three (3/28, 10.7%) adverse pregnancy outcomes were reported in 2 patients. One patient had a twin pregnancy and delivered at 33 weeks after developing preterm premature rupture of membranes at 32 weeks in the setting of a JIA flare. Her second pregnancy was complicated by active JIA before and throughout gestation, and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome at 39 weeks. Another patient with comorbid antiphospholipid syndrome underwent a cesarean birth at 36 weeks for suspicion of HELLP syndrome. Six (6/32, 18.7%) postpartum flares occurred.Conclusion. Women who discontinued their TNFi during pregnancy had a higher risk of peri-or postpartum flare compared to those who continued their TNFi throughout pregnancy.