Anti-TNF Therapy Lowers Gestational Diabetes Risk in IBD

TOPLINE:

Exposure to antitumor necrosis factor (anti-TNF) therapy during the first 140 days of pregnancy is associated with a significant decrease in the risk of developing gestational diabetes (GD) among women with inflammatory bowel disease (IBD).

METHODOLOGY:

• Elevated levels of TNF have been observed in women with GD, suggesting a potential protective effect of anti-TNF therapy.
• Researchers conducted a retrospective analysis of a comprehensive nationwide database of patients in South Korea to identify women with IBD from 2010 to 2021 and investigate the association between use of anti-TNF therapy during pregnancy and risk for GD.
• They compared those with anti-TNF exposure (ie, received prescriptions for infliximab, adalimumab, and golimumab) any time from the last menstrual period (LMP) to LMP + 139 days with those who were unexposed (ie, were either on immunosuppressants or 5-aminosalicylates, or were untreated).
• The study outcome was new-onset GD, assessed from LMP + 140 days until the date of delivery.
• The risk for GD was stratified on the basis of IBD subtypes and patient age (≤ 35 vs > 35 years).

TAKEAWAY:

• Researchers identified 3695 pregnancies in women with IBD that resulted in live births, of which 338 (9.2%) were exposed to anti-TNF therapy and 3357 (90.8%) remained unexposed.
• Overall, 7.1% of pregnancies exposed to anti-TNF therapy and 11.0% of unexposed pregnancies developed GD.
• The use of anti-TNF therapy was associated with a 32% reduction in the risk for GD among pregnant women with IBD.
• The use of anti-TNF therapy was associated with a more pronounced reduction in the risk for GD among patients with Crohn’s disease (adjusted risk ratio [aRR], 0.55) than those with ulcerative colitis (aRR, 0.86).
• The protective effect of anti-TNF therapy against GD was more pronounced among women aged ≤ 35 years (aRR, 0.56) than those aged > 35 years (aRR, 0.98).

IN PRACTICE:

“The results of this study may assist both patients and healthcare providers in making informed decisions regarding the use of anti-TNFs during pregnancy,” the authors wrote.

SOURCE:

The study, led by Yongtai Cho, PharmD, and Eun-Young Choi, PharmD, School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, was published online in The American Journal of Gastroenterology.

LIMITATIONS:

The study’s reliance on prescription data may have led to exposure misclassification, as this does not always indicate actual administration of the drug. Researchers were unable to assess the effect of continuing anti-TNF therapy past 20 weeks of pregnancy. The study was conducted in a single country with a relatively homogeneous ethnicity, limiting the generalizability of the findings to more diverse populations.

DISCLOSURES:

The study was supported by a grant from the National Research Foundation of Korea, which is funded by the Korean government. One author reported serving as a consultant or advisor and receiving speaker fees and grants from multiple pharmaceutical companies outside the submitted work. Another author reported receiving grants from various governmental institutions and pharmaceutical companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.