Pregnant women with immune mediated inflammatory diseases who discontinue biologics have higher rates of disease flare

Background and aims Biologic agents have revolutionized treatment of immune mediated inflammatory diseases (IMIDs). However, despite the benefits of treatment, there is limited data on its use during pregnancy leading to significant variation in practices. We evaluated maternal, neonatal, and disease-related outcomes in pregnant women with IMIDs, comparing those with biologic exposure during pregnancy to those without exposure. Our hypothesis was that there would be no difference in outcomes between the two groups. Methods This is a retrospective cohort study conducted at a single tertiary care center including women with Crohn's disease (CD), ulcerative colitis (UC), ankylosing spondylitis (AS), rheumatoid arthritis (RA), or psoriasis/psoriatic arthritis (PS/PsA) who delivered between 2010 and 2018 at The Ohio State University Wexner Medical Center. Conditions were identified by ICD-9/ICD-10 code and confirmed by chart review. Demographic data, pregnancy outcomes and disease-related data were collected. Results There were 338 pregnancies including 100 with CD, 74 with UC, 15 with AS, 61 with RA, and 90 with PS/PsA. 23% of IMID patients had biologic exposure (biologic use within 3 months of conception) and 18% continued therapy during pregnancy. Those with biologic exposure had increased risk of post-partum disease flare (OR 3.44; 95% CI 1.29, 9.15) and were less likely to breastfeed (OR 0.44; 95% CI 0.23, 0.87). In subgroup analysis of patients with IBD, those with biologic exposure also had increased risk of post-partum flare (OR 4.55; 95% CI 1.27, 16.35). Maternal and neonatal pregnancy outcomes were similar. Conclusion Among pregnant women with IMIDs, those that continued biologics during pregnancy had increased rates of major infection, disease related hospital admission, glucocorticoid use, and disease flare within 6 months post-partum, without any significant change in maternal or neonatal outcomes.

Automated summary

This study aimed to evaluate the differences between pregnant women with immune mediated inflammatory diseases (IMIDs) who were treated with biologic agents during pregnancy and those who were not. The results showed that patients who continued biologic therapy during pregnancy had increased risks of major infection, hospital admission, glucocorticoid use, and post-partum disease flare within 6 months, without significant changes in maternal or neonatal outcomes.