Impact of anti-TNFα exposure in utero on the development of immune systems of exposed children – a controlled, multicentre observational study

Česká verzia

Authors: Ďuricová D. ¹; Dvořáková E. ¹; Hradský O. ²; Mitrová K. ^1,2; Durilová M. ³; Koželuhová J. ⁴; Kohout P. ⁵; Zárubová K. ²; Bronský J. ²; Hradská N. ⁶; Bronská E. ⁷; Adamcová M. ⁷; Machková N. ¹; Hrubá V. ¹; Bortlík M. ^1,8,9; Lukáš M. ¹; Malíčková K. ^1,10
Authors place of work: Klinické a výzkumné centrum pro střevní záněty ISCARE I. V. F., a. s., Praha ¹; Pediatrická klinika 2. LF UK a FN Motol, Praha ²; Klinika dětské chirurgie 2. LF UK a FN Motol, Praha ³; Gastroenterologické a hepatologické oddělení, I. interní klinika LF UK a FN v Plzni ⁴; Interní klinika 3. LF UK a Thomayerovy nemocnice, Praha6 Privátní ordinace PLDD, Litovel ⁵; Privátní ordinace PLDD, Praha ⁷; Interní klinika 1. LF UK a ÚVN, Praha ⁸; Farmakologický ústav 1. LF UK a VFN, Praha ⁹; Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN, Praha ¹⁰
Published in the journal: Gastroent Hepatol 2018; 72(6): 479-485
Category:
doi: https://doi.org/10.14735/amgh2018479

Summary

Background:

Data on safety of in utero exposure to anti-tumor necrosis factor (TNF) α on long-term childhood development are sparse. Our aim was to assess the impact of in utero exposure to anti-TNFα on the postnatal development of immune systems of exposed children.

Methods:

Children (≥ 12 months of age) born to mothers with inflammatory bowel disease (IBD) (2007–2016) treated with anti-TNFα during pregnancy in three centres were included. Unexposed children of non-IBD mothers who came for mandatory check-up to the general pediatrician served as a control group. A predefined questionnaire was distributed by the pediatricians to collect data on the perinatal period, infectious complications, antibiotic use, and vaccination.

Results:

We included 72 exposed and 69 unexposed children (median age 35 months and 50 months, respectively). No significant difference in infectious complications ≤ 1^st year of life (23.9 vs. 17.4%, p = 0.36) or during the whole follow-up (p = 0.32) was found between exposed infants and controls. Concomitant immunosuppressive therapy during pregnancy and anti-TNFα levels in cord blood did not increase the infection rate ≤ 1st year of life (p > 0.05). Protective titers of antibodies to vaccination were found in > 95% of exposed children except for H. influenzae and mumps vaccines. However, these two vaccines had the lowest serologic response in the control group, too.

Conclusions:

Treatment with anti-TNFα during pregnancy seemed to be safe with regard to postnatal development of the immune systems of exposed children.

Key words: inflammatory bowel disease – anti-TNFα – gravidity – infections – vaccination

Submitted: 22. 11. 2018

Accepted: 28. 11. 2018

Zdroje

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