Safety of anti-tumor necrosis factor therapy duringpregnancy in patients with inflammatory bowel disease

Treatment of inflammatory bowel disease has significantlyimproved since the introduction of biologicalagents, such as infliximab, adalimumab, certolizumabpegol, and golimumab. The Food and Drug Administrationhas classified these factors in category B,which means that they do not demonstrate a fetal risk.However, during pregnancy fetuses are exposed tohigh anti-tumor necrosis factor （TNF） levels that aremeasurable in their plasma after birth. Since antibodiescan transfer through the placenta at the end of thesecond and during the third trimesters, it is importantto know the safety profile of these drugs, particularlyfor the fetus, and whether maintaining relapse of thedisease compensates for the potential risks of fetalexposure. The limited data available for the anti-TNFdrugs to date have not demonstrated any significantadverse outcomes in the pregnant women whocontinued their therapy from conception to the firsttrimester of gestation. However, data suggest that anti-TNFs should be discontinued during the third trimester,as they may affect the immunological system of thenewborn baby. Each decision should be individualized,based on the distinct characteristics of the patient andher disease. Considering all the above, there is a needfor more clinical studies regarding the effect of anti-TNF therapeutic agents on pregnancy outcomes.