“International experts will discuss different approaches to IBD during pregnancy, and how recent data may affect treatment decisions during Sunday’s AGA Clinical Symposium The Pregnant Patient with IBD: Data for an International Consensus?!
Christien Janneke van der Woude, MD, MS, professor of IBD at the Erasmus University Medical Center, Rotterdam, Netherlands, will co-moderate the symposium with Uma Mahadevan, MD, professor of medicine and medical director of the Center for Colitis and Crohn’s Disease at the University of California, San Francisco School of Medicine.
“In general, Europeans have a very different approach to the pregnant IBD patient,” Dr. Mahadevan said. “They stop biologics and other medications early in the second trimester because of potential side effects. In North America, we feel that the available side-effect data suggest it is low risk to continue biologics.”
While Dr. van der Woude recommends that clinicians stop biologics around week 22, Dr. Mahadevan tells clinicians to continue biologic treatment “because disease flare is the worst possible thing for their IBD. An IBD flare during pregnancy is strongly associated with adverse outcomes,” she said.
Both positions are firmly based in data. But much of the data regarding pregnancy outcomes and biologics is old, Dr. Mahadevan noted. More recent studies are changing attitudes and practices.
Dr. van der Woude is active in the European Crohn’s & Colitis Organization (ECCO), which is studying outcomes in children born to women with IBD. Dr. Mahadevan is the principal investigator for the Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) Registry, which is looking at similar outcomes in U.S. patients. Some results from the two groups are similar.
The newest data from ECCO on adalimumab suggests that continuing treatment through pregnancy has no significant effect on neonatal outcomes, but stopping treatment leads to flares. For this one agent, at least, the U.S. practice of timing biologic dosing may be helpful.
“We try to give a dose as long as possible before delivery and then soon after delivery,” Dr. Mahadevan explained. “If an agent is dosed every eight weeks, we give a final dose eight to 10 weeks before delivery, or four to five weeks before delivery for agents dosed every four weeks. The goal is to minimize placental transfer of the biologic.”
It’s well known that many biologic agents cross the placental barrier. In some cases, neonates have higher levels of biologics than their mothers, Dr. van der Woude noted.
However, PIANO data show no differences between children born to IBD mothers on anti-TNF agents and those born to the general population in terms of developmental milestones during the first four years of life, risk of infections and congenital anomalies, Dr. Mahadevan said.
“We will be looking at gaps in our knowledge during this symposium,” Dr. van der Woude said. “We do not know what happens in the longer term, when children are 10 or 12. We don’t know yet what the exposure of biologics in utero really does to children. And we need to know more about placental transfer of biologics at the time they are registered. This will be an important part of our discussion.”
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