P447 No severe neonatal and maternal complications in inflammatory bowel diseases patients treated with ustekinumab or vedolizumab during pregnancy
P. Wils1, P. Seksik2, C. Stefanescu3, S. Nancey4, M. Allez5, D. Laharie6, G. Pineton De Chambrun7, R. Altwegg7, C. Gilletta8, L. Vuitton9, S. Viennot10, M. Serrero11, M. Fumery12, G. Savoye13, M. Collins14, F. Goutorbe15, H. Brixi16, G. Bouguen17, N. Tavernier18, M. Boualit19, A. Amiot20, V. Abitbol21, B. Pariente22
1GETAID group, 1Gastroenterology Department, CHRU Lille, Lille, France, 2Gastroenterology, Saint Antoine Hospital, Paris, France, 3Gastroenterology, Beaujon Hospital, Paris, France, 4Gastroenterology, Lyon Sud Hospital, Lyon, France, 5Gastroenterology, Saint Louis Hospital, Paris, France, 6Gastroenterology, Haut-Leveque Hospital, Bordeaux, France, 7Montpellier, Gastroenterology, Montpellier, France, 8Toulouse, Gastroenterology, Toulouse, France, 9Besancon, Gastroenterology, Besancon, France, 10Caen Hospital, Gastroenterology, Caen, France, 11North Hospital of Marseille, Gastroenterology, Marseille, France, 12CHU Amiens Nord, Gastroenterology, Amiens, France, 13Rouen, Gastroenterology, Rouen, France, 14Kremlin-Bicêtre Hospital, Gastroenterology, Paris, France, 15Bayonne, Gastroenterology, Bayonne, France, 16Robert Debré University Hospital, Gastroenterology, Reims, France, 17University Hospital of Rennes, Gatsroenterology, Rennes, France, 18Gastroenterology, Tourcoing, Tourcoing, France, 19Gastroenterology, Valenciennes, Valenciennes, France, 20Gastroenterology, Henri Mondor Hospital, Paris, France, 21Gastroenterology, Cochin Hospital, Paris, France, 22Gastroenterology, University of Lille- CHRU Lille, Lille, France
Background
Inflammatory bowel diseases (IBD) have a high incidence in the female population of childbearing age. Ustekinumab (UST) and vedolizumab (VDZ) are used in IBD after failure of immunosuppressants and//or anti-TNF therapy. Data on the use and safety of these novel biologics in pregnancy are rare.
Methods
We conducted a retrospective cohort study in the GETAID and identified female IBD patients who received at least one injection of UST or VDZ during pregnancy or within the 2 months before conception. The aims of the study were to assess the maternal and neonatal complications in these patients and to assess the management of VDZ or UST during pregnancy.
Results
Seventy-three pregnancies in 68 patients were reported in 21 centres. The median time between UST or VDZ introduction and pregnancy was 11.8 months (IQR: 5.2–17.6) and 10 months (IQR: 5.7–19.5), respectively. Twenty-nine pregnancies occurred in 27 patients on UST resulting in 26 (90%) live births, two (7%) spontaneous abortions, and one (3%) elective termination. Maternal complications were reported in two patients (gestational diabetes and threat of preterm birth). Five (19%) neonatal complications were reported (3 preterm deliveries, one low birth weight and one cardiac malformation). Six (21%) patients received UST in the 2 months before conception and stopped UST with a relapse in one patient (17%). UST was maintained during pregnancy in 22 (79%) patients: 13 patients discontinued UST in the first trimester with a relapse in 4 (31%) patients and 9 patients maintained UST during all pregnancy with a relapse in 3 (33%) patients. Forty-four pregnancies occurred under VDZ resulting in 38 (86%) live births, 5 (11%) spontaneous abortions and one (3%) medical interruption. Maternal complications were reported in 5 women (4 pre-eclampsia and one pregnancy cholestasis). Fourteen (37%) neonatal complications were reported: 7 (18%) premature births, 6 (16%) low birth weights and one (3%) congenital corpus callosum hypoplasia. Fifteen (34%) patients received VDZ in the 2 months before conception and discontinued VDZ with a relapse in 8 (53%) patients. VDZ was maintained during pregnancy in 29 (66%) patients: 16 patients discontinued VDZ in the 1st trimester with a relapse in 8 (50%) patients and 13 patients maintained VDZ during all the pregnancy with a relapse in one (8%) patient.
Conclusion
We reported 73 pregnancies under VDZ or UST. Except one cardiac malformation on UST and one congenital corpus callosum hypoplasia on VDZ, no serious neonatal or maternal complications were observed. However, additional prospective evaluations regarding pregnancy outcomes with new biologics are needed.