Table 1 characteristics and quality of included studies in the meta-analysis
Author | Study design | Disease | Anti-TNFa agent | Control Group | Concomitant Medications | Timing of exposure | Age at conception (mean, year) | Duration of disease (mean, year) | Study quality | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anti-TNFa group | Control Group | Anti-TNFa group | Control group | Anti-TNFa group | Control Group | |||||||
Johnson et al. [29] | p | CD | ADA | Not exposed to anti-TNFa therapy. | Not specified | Not specified | Not specified | Not specified | Not specified | Not specified | Not specified | ******* |
Schnitzler et al. [24] | R | CD, UC and indeterminate colitis | IFX, ADA | Not exposed to anti-TNFa during pregnancy or 3 months before. | 5- ASA: 12/42 AZA/6MP : 22/42 Steroids: 3/42 | Not specified | Within 3 months prior conception, and/or During pregnancy (up to end of 2nd trimester). | 29 | 27 | Not specified | Not specified | ******* |
Mahadevan et al. [28] | P | CD and UC | IFX, ADA, CZP | Not exposed to anti-TNFa therapy. | 5-ASA, steroids, antibiotics | 5-ASA, steroids, antibiotics | Not specified. | Not specified | Not specified | Not specified | Not specified | ******* |
Casanova et al. [25] | R | CD and UC | IFX, ADA, CZP | Not exposed to anti-TNFa during pregnancy or 3 months before. | AZA: 36/66, 6-MP: 1/66 | 5-ASA: 240/318, Steroids: 6/318, 5-ASA + Steroids:22/318 | 21% discontinued the treatment at conception, 20% during the first trimester, 29% during the second trimester, and 30% of pregnancies continued with anti-TNFα drugs during the third trimester of gestation. | Not specified | Not specified | Not specified | Not specified | ******* |
Seirafi et al. [15] | R + P | UC, CD and IBD unclassified | IFX, ADA, CZP | Not exposed to anti-TNFa during pregnancy or 3 months before. | AZA (16%), 6MP (1.5%), CsA (0.7%), 5ASA (4.5%), steroids (8%) | Thiopurines(39.5%), 5ASA and/or steroids (39.5%) | 73% stopped preventively before week 30; 20% continued until delivery. | 29.3 | 28.9 | 9.3 | 9.9 | ******** |
Diav-Citrin et al. [21] | P | CD and UC | IFX, ADA | Not exposed to anti-TNFa during pregnancy or 3 months before. | Not specified | Not specified | Not specified | Not specified | Not specified | Not specified | Not specified | ******** |
Komoto et al. [26] | R | CD and UC | IFX, ADA | Pregnancies not exposed to anti-TNFa. | AZA(8/34) Steroids + AZA(2/34) | AZA (6/38), 5ASA (28/38), 6MP (1/38) | During pregnancy | 31.2 | 30.1 | 6.6 | 7.6 | ******* |
Lichtenstein et al. [20] | P | CD | IFX | Not exposed to anti-TNFa therapy during pregnancy | 5-ASA, Steroids, Immunosuppressive drugs, Antibiotics | 5-ASA, Steroids, Immunosuppressive drugs, Antibiotics | Exposure ≤ 365 days before the date of the delivery | Not specified | Not specified | 6.1 | 6.6 | ******* |
Luu et al. [19] | R | CD | IFX, ADA, CZP, golimumab | Pregnancies not exposed to anti-TNFα | AZA: 198/1457 MCT: 25/1457 | AZA: 1256/9819 MCT: 50/9818 | 18.3% stopped before week 12, 33.8% stopped between week 12–24, 48% continued after 24 weeks, 31.6% continued after 37 weeks. | 29.4 | 31 | Not specified | Not specified | ****** |
Moens et al. [27] | R | CD and UC | IFX, ADA | Pregnancies unexposed to immunomodulatory and biologic | Immunomodulators (39/186) Steroids (14/186) | Steroids (25/184) | For IFX: 20% discontinue during 1st trimester, 39% during 2nd trimester, 13% during 3rd trimester, 28% continued throughout pregnancy. For ADA: 8% continued during 1st trimester, 32% during 2nd trimester, 18% during 3rd trimester, 23% continued throughout pregnancy. | 30 | 31 | 7 | 6 | ******* |
Meyer et al. [23] | R | CD and UC | IFX, ADA, CZP, golimumab | Pregnancies not exposed to anti-TNFα | Thiopurines (839/4364) Steroids (1233/4364) | Thiopurines (3554/23,365) Steroids (5387/23,365) | 14.5% during the trimester before pregnancy, 13.3% during 1st trimester, 11.3% during 2nd trimester, 3.4% during 3rd trimester | 29 | 30 | 4.3 | 5.6 | ****** |