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Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab

Journal of Crohn's and Colitis, ISSN: 1876-4479, Vol: 13, Issue: 1, Page: 12-18
2019
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Article Description

Background and Aims: Vedolizumab is an IgG1 anti-α4β7 integrin antibody approved for the treatment of inflammatory bowel diseases [IBD], but without clear safety data during conception, pregnancy and nursing. Animal studies showed that mucosal vascular addressin cell adhesion molecule 1 [MAdCAM-1] is expressed by maternal vessels in the placenta and recruits α4β7-expressing cells that are considered important for maternal/fetal tolerance. Blocking this interaction by vedolizumab might affect this process. We aimed to evaluate pregnancy outcomes in vedolizumab-treated female IBD patients. Methods: We conducted a retrospective, multicentre Belgian observational study. Details on disease activity, prenatal complications, delivery and neonatal outcome were collected through a case report form. Results: Twenty-four pregnancies were reported. Five women had active disease at conception and one patient flared during pregnancy. There were 23 live births. Complications were observed in 25% of pregnancies [premature rupture of membranes, pre-eclampsia, miscarriage, elective termination and stillbirth] and in 35% of infants [prematurity, intra-uterine growth retardation, small for gestational age and congenital malformations including hip dysplasia, pulmonary valve stenosis and Hirschprung’s disease]. Vedolizumab was continued throughout pregnancy in two females and stopped in the 1st and 2nd trimester in five and 16 patients, respectively. For live born children, the median [interquartile range] gestational age, weight and Apgar score 5 min after birth were 39 [37–39.6] weeks, 3270 [3080–3585] grams and 10 [9–10], respectively. Conclusions: Although several complications were observed, both in mothers and in newborns, no firm conclusions can be drawn. Awaiting prospective and controlled registries, vigilance and strict follow-up of pregnant patients treated with vedolizumab seems mandatory.

Bibliographic Details

Annick Moens; Séverine Vermeire; Marc Ferrante; Karen Van Hoeve; Evelien Humblet; Jean François Rahier; Peter Bossuyt; Sophie Dewit; Denis Franchimont; Elisabeth Macken; Jochen Nijs; Annelies Posen; Beatrijs Strubbe; Anneleen Van Hootegem; Wouter Van Moerkercke; P. Hindryckx; F. Baert; Saskia Appelmans

Oxford University Press (OUP)

Medicine

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