Abstract
Crohn's disease is a chronic disease, which commonly affects women during their reproductive years. Poorly treated Crohn's disease is associated with adverse pregnancy outcomes. Biologics, a group of therapeutic drugs targeting inflammatory mediators including anti-TNF, anti-integrins and anti-interleukins, are increasingly used in pregnant women with Crohn's disease, exposing both the women and their fetuses to treatment-related complications. At present, it is unclear which biologics are more superior. This study performed a systematic review and meta-analysis to assess the risk of adverse pregnancy outcomes in women with Crohn's disease after exposure to biologics. Bibliographic databases were searched from inception to May 2021. The outcomes of interest were preterm delivery, low birth weight, spontaneous abortion, and congenital abnormalities. A total of 11 studies comprised of 1,875 pregnancies among women with Crohn's disease were included. Of these, 1,162 received biologics and 713 received non-biologic therapy. During the remission phase of the disease, the use of biological therapy increased the risk of adverse pregnancy outcomes, of which anti-integrins were associated with a higher incidence of adverse pregnancy outcomes than anti-TNF and anti-interleukins.Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO, identifier: CRD42020191275.
Highlights
Crohn’s disease (CD) is a complex and life-long gastrointestinal inflammatory disease, characterized by gastrointestinal inflammation and several extraintestinal manifestations, leading to progressive intestinal injury and disability
When comparing between anti-interleukins and anti-TNF, there was no significant difference in the risk of preterm deliveries (OR: 1.48; 95% confidence interval (CI): 0.89, 2.47; P = 0.13) with no significant heterogeneity between the studies (P = 0.97, I2 = 0%)
Further statistical comparison between anti-integrins and antiinterleukins revealed significantly higher risk of preterm deliveries among patients treated with anti-interleukins (OR: 2.07; 95% CI: 1.21, 3.55; P = 0.008), without significant heterogeneity between the studies (P = 0.23, I2 = 28%; Figure 2)
Summary
Crohn’s disease (CD) is a complex and life-long gastrointestinal inflammatory disease, characterized by gastrointestinal inflammation and several extraintestinal manifestations, leading to progressive intestinal injury and disability. Studies reporting on CD and birth outcomes may not always distinguish the impact of disease activity, drug use and CD severity on APOs [7]. It seems necessary for pregnant women with CD to receive medical specialist consultation to prevent the potential risk to the newborns. Increased awareness and understanding of the disease activity before and during pregnancy associated with the greatest risk of poor maternal and infant outcomes [8, 9] have encouraged more research to produce evidence and guidance on a treatment strategy that strives to achieve a balance between the risks of active disease and the risks of medications [10]
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