In part I of this blog post “IBD, Biologics, & Your Liver” we discussed the potential risk of anti-tumor necrosis factor antagonists causing liver damage. In this post, we will discuss the effects biologics can have on pregnancy. Women with IBD who become pregnant can present quite a challenge in their disease and drug management. A new study in Clinical Gastroenterology & Hepatology investigated the effect (placental transfer) of Anti-TNF drugs in pregnant women with inflammatory bowel disease (IBD) and whether different TNF agents have different rates of transfer.
The researchers studied 31 pregnant women with IBD, 11 receiving infliximab (Remicade) 10 receiving adalimumab (Humira), and 10 receiving certolizumab (Cimzia). At birth, they discovered the infants had significantly higher concentrations of infliximab (160% higher) and adalimumab (153% higher) than their mothers. For certolizumab, the median level was only 3.9% higher than in the mother. The researchers also discovered concentrations of infliximab and adalimumab could be detected in the infants for as long as 6 months.
Another study assessed the effects of discontinuing these medications during pregnancy on the course of IBD and newborn exposure. Researchers followed 31 pregnancies where these medications were discontinued before gestational week 30. All women receiving infliximab remained in remission, 2 women receiving adalimumab had relapses. The authors concluded, “Discontinuation of anti-TNF therapy appears to be safe for pregnant women with quiescent IBD. However, these drugs are still detected in cord blood samples.”
As the use of anti-TNF therapy in difficult to treat IBD has increased, it is important to understand what effects these medications have on the pregnant patient, fetus, and newborn. One of the biggest implications resulting from the use of anti-TNF antagonists in pregnancy is the potential infection risk to these infants with high concentrations of these biologics medications. If you received anti-TNF agents throughout pregnancy, it’s imperative you let your pediatrician know as these infants should not be administered any live virus vaccines (i.e. rotavirus, flu mist) within the first 6 months of life. Now whether they should receive vaccines of any kind is another topic altogether and not the objective of this blog post. These infants should also be more closely monitored for acute illnesses and receive adequate immune support, via natural therapies.
Individuals with IBD should be advised/educated on all these possible adverse effects when being counseled on their options for treatment. The good news is naturopathic medicine has a lot to offer individuals suffering with IBD. Dr. Nate Champion has a special focus in the treatment of IBD and utilizes safe, gentle, and effective therapies that work to stimulate your body’s amazing ability to heal itself, rather than using therapies that suppress the body’s immune system. These therapies are also safe during pregnancy and breastfeeding.
Do you or someone you know suffer from IBD? Share naturopathic medicine with them today!