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Decreased Risk of Preeclampsia in Women with Inflammatory Bowel Disease on Anti-Tumor Necrosis Factor Therapy

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Abstract

Background

Evidence suggests that upregulation of tumor necrosis factor-alpha (TNF-α) plays a role in immune dysregulation in both preeclampsia and inflammatory bowel disease (IBD).

Aims

We aimed to investigate whether anti-TNF therapy during pregnancy decreases the risk of preeclampsia in women with IBD.

Methods

The study population included women with IBD and pregnancies who were followed at a tertiary care center from 2007 to 2021. Cases of preeclampsia were compared with controls with a normotensive pregnancy. Data on patient demographics, disease type and activity, pregnancy complications, and additional risk factors for preeclampsia were collected. The association between anti-TNF therapy and preeclampsia was analyzed using univariate analysis and multivariate logistic regression.

Results

Women with preeclampsia were more likely to have a preterm delivery (44% vs. 12%, p < 0.001). More women without preeclampsia were exposed to anti-TNF therapy during pregnancy than women with preeclampsia (55% vs. 30%, p = 0.029). The majority of women (32/44) on anti-TNF therapy, either adalimumab or infliximab, continued to have some degree of exposure during the third trimester. Though not significant, multivariate analysis showed a trend towards a protective effect of anti-TNF therapy against developing preeclampsia if exposed during the third trimester (OR 0.39; 95% CI 0.14–1.12, p = 0.08).

Conclusions

In this study, anti-TNF therapy exposure was higher in IBD patients who did not develop preeclampsia than in those who did. While not significant, there was a trend towards a protective effect of anti-TNF therapy against preeclampsia if exposed during the third trimester.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Nisha B. Patel

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Daniela Guerrero Vinsard & Sunanda V. Kane

  3. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA

    Andrea G. Kattah

Authors
  1. Nisha B. Patel
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  2. Daniela Guerrero Vinsard
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  3. Andrea G. Kattah
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  4. Sunanda V. Kane
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Contributions

Guarantor of article: Professor SK. NBP collected and analyzed data, and co-wrote, edited, and revised the manuscript. DGV analyzed data, co-wrote, edited, and revised the manuscript. AGK initiated, designed, and led the study, analyzed data, and critically reviewed the manuscript. SVK led the study, performed statistical analysis, analyzed data, and critically reviewed the manuscript. All authors approved the final version of the article.

Corresponding author

Correspondence to Nisha B. Patel.

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Conflict of interest

Sunanda Kane received consulting fees from Janssen, the manufacturers of an anti-TNF biologic therapy.

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Patel, N.B., Vinsard, D.G., Kattah, A.G. et al. Decreased Risk of Preeclampsia in Women with Inflammatory Bowel Disease on Anti-Tumor Necrosis Factor Therapy. Dig Dis Sci 68, 3557–3561 (2023). https://doi.org/10.1007/s10620-023-08016-x

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  • DOI: https://doi.org/10.1007/s10620-023-08016-x

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