Should Screening For Latent Tuberculosis Infection Be Repeated After Travel To Tuberculosis Endemic Areas In Patients Treated With TNF-Alpha Inhibitor Therapy?

safety," "infliximab," "adalimumab," & "certolizumab."Articles and abstracts published in English documenting birth outcomes after maternal drug exposure within 3 months of conception or during any trimester of pregnancy were included.Reference lists of the primary articles were hand-searched to identify additional studies.RESULTS: The initial search yielded 11,452 citations.Fifty studies met criteria for full review, including 13 case series, 36 case reports, and 2 prospective studies with control groups.The total number of patients exposed to anti-TNFs was 471 (IFX 195/ADA 259/CTZ 17).Of these, 404 exposures (85.8%) resulted in live births.Nineteen congenital abnormalities associated with live births (4.1%) were recorded (IFX 6/ADA 12/CTZ 0).No pattern of specific birth defects was identified.Seven miscarriages, 28 spontaneous abortions, and 2 stillbirths were recorded for a total of 37 (7.9%) fetal deaths.Seven (5.7%) low birth weight infants were reported.These are similar to rates in the general US population (ephtracking.cdc.gov) and in women with IBD unexposed to anti-TNFs (Dominitz J et al.AJG 2002).Thirty nine (19%) preterm or premature births were recorded.This rate is slightly higher than that of the US population but may be expected in the IBD population (Cornish et al.Gut 2007).Limitations include small samples, paucity of studies with control groups, and inability to adjust for comorbidities, concomitant medications, and disease activity.CONCLUSION: These data suggest that the rates of congenital malformations and adverse birth events are similar to those in the general population and in the pregnant IBD population.Although promising, there is insufficient evidence to prove absolute safety for use of anti-TNFs during pregnancy given the lack of controlled trials.