While the directionality of this cannot be determined from the data, it is presumed that therapy was changed because of active disease, rather than that disease activity was a result of a change in therapy. Practitioners have generally become more comfortable using biologics in the first trimester of pregnancy. congenital malformations, spontaneous abortions, preterm birth, LBW, and infections over the first year of life. Higher disease activity was associated with risk of spontaneous abortion (HR 3.41, 95% CI 1.51C7.69) and preterm birth with increased infant infection (OR 1.73, 95% CI 1.19C2.51). Conclusions Biologic, thiopurine, PETCM or combination therapy exposure during pregnancy was not associated with increased adverse maternal or fetal outcomes at birth or within the first year of life. Therapy with these agents can be continued throughout pregnancy in women with IBD to maintain disease control and reduce pregnancy related adverse events. (“type”:”clinical-trial”,”attrs”:”text”:”NCT00904878″,”term_id”:”NCT00904878″NCT00904878) for height or weight was defined as 25th percentile. Infant intensive care unit (ICU) admission, congenital malformations and maternal reported infant infections were collected. Infections were categorized into serious infections (requiring hospitalization) or non-serious infection (any reported infection without hospitalization). Due to the frequency of otitis media in childhood, sensitivity analyses were repeated excluding this infection. Developmental Milestones Developmental milestones were assessed through the nationally validated 65 (29%)37 (18%) br / 115 (55%) br / 57 (27%)0.02Recreationa 1 Drug Use n (%) Current Former (prior to pregnancy) Never1 (0.1%) br / 65 (5%) br / 1,321 (95%)1 (0.3%) br / 22 (6%) br / 327 (93%)0 (0%) br / 26 (4%) br / 573 (96%)0 (0%) br / 10 (4%) br / 216 (96%)0 (0%) br / 7 (3%) br / 202 (97%)0.42 Open in a separate window *Biologics defined as anti-TNF, anti-integrin, anti-IL 12/23 #Thiopurine (azathioprine or 6-mercaptopurine) **Combination defined as biologic + thiopurine ^Pre-pregnancy BMI as reported at intake Pregnancy Outcomes There were 133 (9%) infants with congenital malformations, 42 (3%) SABs, 91 (7%) LBWs, and 132 (10%) preterm births. There were 58 (4%) SGA, 30 (2%) IUGRs, 5 (0.30%) stillbirths, 613 (44%) cesarean sections, 137 (10%) neonatal ICU stays, and 280 (20%) patients with at least one self-reported pregnancy related complication (excluding cesarean section, IUGR or pre-term delivery). There were overall no differences in rates of pregnancy complications by drug class, although women on biologics and combination therapy had higher rates of cesarean sections as compared to the unexposed population (Table 2, Table S3). No pattern of congenital malformations suggests an association for a specific drug or disease type (CD or UC). (Table S6). Table 2: Pregnancy related complications by drug exposure, controlling for maternal age, steroid use and disease activity (Odds Ratio (95% Confidence Interval)) thead th align=”left” valign=”top” PETCM rowspan=”1″ colspan=”1″ Event /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ PETCM No Exposure (n=379) /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Biologics* (n=642) /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Thiopurine# (n=242) /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Combination** (n=227) /th /thead Any Pregnancy Complication^1.0 (Ref)1.2 (0.8, 1.7)1.3 (0.8, 2.0)0.8 (0.5, 1.3)Spontaneous Abortion (Only Gestation Ages = 140 Days)1.0 (Ref)1.3 (0.5, 3.3)1.4 (0.4, 4.2)1.2, (0.4, 3.8)Spontaneous Abortion (Most Gestation Ages)1.0 (Ref)1.3 (0.5, 3.0)1.3 (0.4, 3.8)1.1 (0.3, 3.3)Preterm Birth ( 37 weeks)1.0 (Ref)0.9 Rabbit polyclonal to PON2 (0.5, 15)1.4 (0.8, 2.6)1.8 (1.0, 3.3)Small for Gestational Age1.0 (Ref)1.1 (0.5, 2.0)0.5 (0.2, 15)0.7 (0.3, 1.8)Low Birth Excess weight ( 2500 g)1.0 (Ref)1.0 (0.5, 18)0.6 (0.3, 15)1.2 (0.6, 2.5)Intrauterine Growth Restriction1.0 (Ref)0.6 (0.2, 14)0.3 (0.07, 15)0.7 (0.2, 2.3)Cesarean Section1.0 (Ref)1.3 (1.0, 18)1.3 (0.9, 19)1.7 (1.1, 2.5)NICU at Birth1.0 (Ref)1.1 (0.7, 19)1.2 (0.6, 2.2)1.5 (0.8, 2.8)Congenital Malformations1.0 (Ref)1.5 (0.9, 2.5)1.4 (0.8, 2.7)1.6 (0.8, 3.1)Any of The Above1.0 (Ref)1.5 (1.1, 2.0)1.6 (1.1, 2.3)1.4 (0.9, 2.0)Any of the Above w/o Considering Cesarean Section1.0 (Ref)1.2 (0.9, 16)1.4 (1.0, 2.0)1.2 (0.8, 1.8) Open in a separate window *Biologics defined as anti-TNF, anti-integrin, anti-IL 12/23 #Thiopurine (azathioprine or 6-mercaptopurine) **Combination defined as biologic + thiopurine ^Defined while any self-reported pregnancy complication (excludes intrauterine growth restriction, cesarean section or pre-term delivery) Logistic regression models controlling for maternal age, steroid use, and disease activity Analyzing those entering the cohort prior to 20 weeks, the pace of SAB was.
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