Safety of Anti-TNF-Alpha Therapy During Pregnancy on Longterm Outcome of Exposed Children: A Controlled, Multicenter Observation
Safety of Anti-TNF-Alpha Therapy During Pregnancy on Longterm Outcome of Exposed Children: A Controlled, Multicenter Observation
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DOI：
10.1093/ibd/izy294
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发表时间：
2019-04-01
影响因子：
4.9
通讯作者：
Lukas, Milan
中科院分区：
文献类型：
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作者：
Duricova, Dana;Dvorakova, Eva;Lukas, Milan
背景：宫内暴露于抗肿瘤坏死因子-α对儿童长期发育的影响的证据有限。研究的目的是评估母亲炎症性肠病(IBD)引起的宫内抗肿瘤坏死因子-α暴露对暴露儿童出生后长期发育的影响。方法：在捷克共和国的3个中心，研究对象为患有炎症性肠病(IBD)的母亲(2007-2016)在孕期连续接受抗肿瘤坏死因子-α治疗的孩子(年龄=12个月)。对照组由在普通儿科医生办公室接受强制性检查的非IBD母亲的未接触过的儿童组成。儿科医生使用预先定义的问卷，收集了围产期、精神运动发育、疫苗接种、感染、抗生素和过敏的数据。结果：72名暴露于暴露的儿童和69名未暴露的儿童(中位年龄分别为35个月和50个月)。接触组儿童的生长发育和精神运动发育与对照组相似。出生1年内感染并发症发生率(23.9%比17.4%；P=0.36)和整个随访期间的感染并发症发生率与对照组无显著差异(P=0.32)。妊娠期间伴随的免疫抑制药物和脐带血中的抗肿瘤坏死因子-α水平与出生一年内感染率的升高无关(P>；0.05)。除嗜血杆菌和流行性腮腺炎疫苗外，超过95%的暴露儿童对疫苗有足够的血清学反应。两组之间的临床表现相似(P=0.98)。结论：与非IBD妇女的未暴露的儿童相比，宫内暴露于抗TNF-α似乎不会在感染并发症、过敏、生长或精神运动发育方面对儿童的出生后发育产生负面影响。
Background: Evidence of the impact of in utero exposure to anti-tumor necrosis factor (TNF)-alpha on long-term childhood development is limited. The aim was to assess the impact of in utero exposure to anti-TNF-alpha due to mothers' inflammatory bowel disease (IBD) on long-term postnatal development of exposed children.Methods: We included consecutive children (>= 12 months of age) born to mothers with IBD (2007-2016) treated with anti-TNF-alpha during pregnancy in 3 centers in the Czech Republic. A control group was comprised of unexposed children of non-IBD mothers undergoing mandatory check-ups at general pediatricians' offices. Data on perinatal period, psychomotor development, vaccination, infections, antibiotics, and allergy were collected by treating pediatricians using a predefined questionnaire.Results: Seventy-two exposed and 69 unexposed children were included (median age, 35 and 50 months, respectively). Exposed children had growth and psychomotor development similar to controls. There was no significant difference in infectious complications within the first year of life (23.9% vs 17.4%; P = 0.36) or during the whole follow-up between exposed infants and controls (P = 0.32). Concomitant immunosuppressants during pregnancy and anti-TNF-alpha levels in cord blood were not associated with elevated infection rate within the first year of life (P > 0.05). Over 95% of exposed children had adequate serologic response to vaccination, except for haemophilus and mumps vaccines. Clinically manifested allergy was similar between the groups (P = 0.98).Conclusions: Anti-TNF-alpha exposure in utero does not seem to have a negative impact on postnatal development of children with regard to infectious complications, allergy, growth, or psychomotor development when compared with unexposed children of non-IBD women.