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Patterns of Biologic Use During Autoimmune Pregnancy

While it is highly desirable to avoid medications during conception and pregnancy, statistics show that >90% of women take at least one drug during pregnancy and nearly half will take 3 or more medications during pregnancy.

This becomes problematic in autoimmune patients, many of whom are women of child bearing potential, who may have active disease that mandates the use of corticosteroids, immunosuppressives or biologics to maintain maternal health.

This issue was studied by Tsao et al who showed increased biologic utilization of biologics and high rates of discontinuation during pregnancy in women with autoimmune disease. 

A Canadian cohort of women with one or more autoimmune diseases was studied between January 1st, 2002 and December 31st, 2012; those with >1 biologic before, or during, pregnancy were included.

Among 6,218 women (8,431 pregnancies) with autoimmune diseases, they found 131 women (144 pregnancies) exposed to a biologic before or during pregnancy.  This included women with RA (51%), IBD 46%, JIA 8%, AS 6% and MS 5%. 

Biologic use increased over 12 years from 0% to 5.7% by 2012 (p<0.001). Within the first trimester of pregnancy, 31% (34/110) of women discontinued their biologic and 38% (30/79) discontinued in the second trimester, while 98% (50/51) of those who were on treatment in the second trimester remained on treatment in the third trimester.

Women with rheumatoid arthritis (RA) had three times greater odds (OR 3.40 [95%CI 1.33-8.71]) of discontinuing biologics during pregnancy, compared to those with inflammatory bowel disease.

These data suggest the need for more research regarding the use, risks and benefits of biologics on fetal and maternal health.

The author has no conflicts of interest to disclose related to this subject

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