Children exposed in utero to medications used to treat inflammatory bowel disease (IBD) are not at increased risk of antibiotic-treated infection or severe infection requiring hospitalization, according to new findings. Prenatal exposure to anti-tumor necrosis factor-alpha (anti-TNF-alpha) or thiopurines were also not associated with increased risk of adverse vaccine reactions, growth failure, autoimmune disease or malignancy, Dr. Shannon Linda Kanis of Erasmus Medical Center in Rotterdam, The Netherlands, and colleagues found. While the use of IBD drugs in pregnancy has not been linked to adverse pregnancy outcomes, the authors note in Gut, "the impact on the development of children's immune system, growth and risk of autoimmune diseases and malignancies later in life is poorly understood." To better understand long-term outcomes, they looked at 1,000 children born to 626 mothers with IBD in 1999-2019. Sixty-one percent of mothers had Crohn's disease, 36% had ulcerative colitis and 3% had unclassified IBD. Overall, 196 children (20%) were exposed to anti-TNF-alpha, including 60 who were also exposed to thiopurines, and 240 (24%) were exposed to thiopurine monotherapy. Using the 564 children not exposed to either drug as controls, the authors found no significant associations between in utero exposure to IBD treatment and adverse health outcomes. There was an increased risk of intrahepatic cholestasis of pregnancy in children exposed to thiopurines, but this did not affect birth outcomes or children's long-term health. "Anti-TNF-alpha and thiopurines, as monotherapy or combination treatment, may be used during pregnancy to maintain disease remission," the authors state. "Therapeutic drug monitoring during pregnancy should be introduced in the case of thiopurine use to avoid maternal exposure to high levels of 6-methylmercaptopurine (6-MMP)." Dr. Kanis was not available for an interview by press time. —Reuters Staff Source
