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A Narrative Review on Anti-Tumor Necrosis Factor α Therapies in Inflammatory Bowel Disease During Pregnancy: Immunoglobulin Placental Translocation and its Impact

2019-04-30Journal article Open access
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dc.contributor.authorRoseira, J
dc.contributor.authorRamos, J
dc.date.accessioned2019-06-07T09:55:32Z
dc.date.available2019-06-07T09:55:32Z
dc.date.issued2019-04-30
dc.description.abstractINTRODUCTION: Inflammatory bowel disease activity is associated with adverse pregnancy outcomes. Anti-tumor necrosis factor α therapy is often required to treat flares and to maintain disease remission. However, there are concerns regarding treatment with these agents during pregnancy, as they actively cross the placental barrier. MATERIAL AND METHODS: Studies regarding anti-tumor necrosis factor α therapy during pregnancy were identified from PubMed from 1958 to January 2018. The reference lists of the selected studies were reviewed to identify complementary publications. RESULTS AND DISCUSSION: Anti-tumor necrosis factor α agents are efficient treatments for moderate-to-severe inflammatory bowel disease and may ensure remission during pregnancy. Although these drugs cross the placenta, they are considered safe for both the mother and the fetus. Furthermore, up-to-date guidelines support therapy continuation during pregnancy aiming for disease control. The same guidelines also consider stopping treatment during the third trimester to limit maternal-fetal drug transfer. However, data shows that this strategy does not completely prevent fetus exposure. In addition, stopping treatment incurs in risk of disease flare and threatens subsequent therapy response. Fetus drug exposure has not showed an association with adverse childhood development. However, as infant drug levels could be detected up to seven months after birth, postponement of live virus vaccination is recommended. CONCLUSION: There should be no disagreement among the medical community as to the need to maintain therapy aiming for disease remission during gestation in inflammatory bowel disease. Anti-tumor necrosis factor α agents are safe for both the mother and the fetus.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationActa Med Port. 2019 Apr 30;32(4):305-312.pt_PT
dc.identifier.doi10.20344/amp.11482pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3271
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherOrdem dos Médicospt_PT
dc.subjectCHLC GASpt_PT
dc.subjectAdalimumab / pharmacokineticspt_PT
dc.subjectAdalimumab / therapeutic usept_PT
dc.subjectAdrenal Cortex Hormones / adverse effectspt_PT
dc.subjectAdrenal Cortex Hormones / pharmacokineticspt_PT
dc.subjectAdrenal Cortex Hormones / therapeutic usept_PT
dc.subjectAnti-Inflammatory Agents / pharmacokinetics
dc.subjectAnti-Inflammatory Agents / therapeutic use
dc.subjectAntibodies, Monoclonal / pharmacokinetics
dc.subjectAntibodies, Monoclonal / therapeutic use
dc.subjectCertolizumab Pegol / pharmacokinetics
dc.subjectCertolizumab Pegol / therapeutic use
dc.subjectFemale
dc.subjectHumans
dc.subjectInflammatory Bowel Diseases / drug therapy
dc.subjectInfliximab / pharmacokinetics
dc.subjectInfliximab / therapeutic use
dc.subjectMaternal-Fetal Exchange
dc.subjectPlacenta / metabolism
dc.subjectPractice Guidelines as Topic
dc.subjectPregnancy
dc.subjectPregnancy Complications / drug therapy
dc.subjectPregnancy Trimesters / metabolism
dc.subjectTumor Necrosis Factor-alpha / antagonists & inhibitors
dc.titleA Narrative Review on Anti-Tumor Necrosis Factor α Therapies in Inflammatory Bowel Disease During Pregnancy: Immunoglobulin Placental Translocation and its Impactpt_PT
dc.title.alternativeRevisão Narrativa Sobre a Terapêutica com Agentes Anti-Tumor Necrosis Factor α na Doença Inflamatória Intestinal Durante a Gravidez: Translocação Placentária de Imunoglobulinas e seu Impactopt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage312pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage305pt_PT
oaire.citation.titleActa Médica Portuguesapt_PT
oaire.citation.volume32pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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