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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2018; 72(6): 479–485. doi:10.14735/amgh2018479.

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

Dana Ďuricová  1, Eva Dvořáková2, Ondřej Hradský3, Katarína Mitrová  1,4, Marianna Durilová5, Jana Koželuhová  6, Pavel Kohout  7, Kristýna Zárubová8, Jiří Bronský  3, Nora Hradská9, Eva Bronská10, Miroslava Adamcová10, Naděžda Machková  1, Veronika Hrubá1, Martin Bortlík  1,11,12, Martin Lukáš  1, Karin Malíčková  1,13, Milan Lukáš  1

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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 ≤ 1st 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.


anti-TNFα, gravidity, inflammatory bowel disease, infection, vaccination

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