Anti-TNF treatment advised for pregnant women and children with bowel disease

Pregnant women and children with inflammatory bowel disease (IBD) should be treated with anti-tumor necrosis factor therapy because active disease poses a greater risk than most medications used to induce and maintain remission, urges the new London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organisation.

The authors recommend infliximab, adalimumab, or certolizumab during pregnancy. The safety of natalizumab during pregnancy isn’t known. Infliximab and certolizumab are apparently safe during breastfeeding; no safety data are available for adalimumab. For children, infliximab (scheduled infusions rather than episodic therapy) and adalimumab are effective in Crohn’s disease and ulcerative colitis; natalizumab is also effective in Crohn’s disease. No data exist for certolizumab in children.

Lead author Uma Mahadevan, MD, of the University of California San Francisco Center for Colitis and Crohn’s Disease suggests that the risk of the untreated disease is greater than the risk of most medications. During pregnancy, active disease can cause preterm birth or miscarriage. In childhood, lack of treatment can adversely affect physical and emotional growth and development.

The position statement recommends vaccinating infants who have been exposed to biological therapy in utero according to standard schedules during the first 6 months of life. Live-virus vaccines such as rotavirus are contraindicated, however, because of the risk of infection. Inactivated vaccines are considered safe, even for immunocompromised children.

The statement was published online December 14 in the American Journal of Gastroenterology.