单克隆抗体治疗在妊娠和产后的风险和益处:产妇、产科和新生儿的考虑因素。

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY
Natalie E Wickenheisser, Amanda M Craig, Jeffrey A Kuller, Sarah K Dotters-Katz
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引用次数: 0

摘要

重要性:自身免疫和风湿病会导致多种不利的孕产妇、产科和新生儿结局,尤其是在怀孕期间。尽管存在许多控制这些情况的药物,但对其安全性的担忧往往不必要地限制了它们的使用。目的:我们旨在回顾目前描述单克隆抗体(mAb)治疗在妊娠和产后使用的证据,并了解其使用对发育中的胎儿和新生儿的影响。证据获取:回顾了原始研究文章、综述文章、病例系列和病例报告以及妊娠指南。结果:妊娠期使用抗肿瘤坏死因子(TNF)药物的多项回顾性(包括1924名患者)和前瞻性研究(包括899名患者)发现,与对照组相比,流产、早产或先天性畸形的发生率没有显著增加。包括美国妇产科学会和母婴医学会在内的大多数学会都建议患有自身免疫性疾病的患者在怀孕期间开始或继续使用TNF-α抑制剂。据报道,新生儿轻度感染的风险增加,尽管需要住院治疗的感染很少。数据表明,母乳喂养同时服用抗TNF药物对新生儿是安全的。关于在妊娠和产后使用其他单克隆抗体,包括抗细胞因子、抗整合素和抗B细胞剂的数据较少。结论和相关性:目前的证据表明,单克隆抗体,特别是抗TNF药物,在妊娠期和产后是安全的,对孕妇或婴儿没有显著的不良影响。对孕妇进行持续疾病控制的好处是有利于产妇和新生儿的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Risks and Benefits of Monoclonal Antibody Therapy During Pregnancy and Postpartum: Maternal, Obstetric, and Neonatal Considerations.

Importance: Autoimmune and rheumatologic conditions can lead to multiple adverse maternal, obstetric, and neonatal outcomes, especially if they flare during pregnancy. Although many medications to control these conditions exist, concerns regarding their safety often unnecessarily limit their use.

Objective: We aim to review the current evidence available describing the use of monoclonal antibody (mAb) therapeutics in pregnancy and postpartum and understand the impact of their use on the developing fetus and neonate.

Evidence acquisition: Original research articles, review articles, case series and case reports, and pregnancy guidelines were reviewed.

Results: Multiple retrospective (including 1924 patients) and prospective studies (including 899 patients) of anti-tumor necrosis factor (TNF) agent use in pregnancy found no significant increase in rates of miscarriage, preterm birth, or congenital anomalies compared with controls. Most societies, including American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine, recommend initiation or continuation of TNF-α inhibitors during pregnancy for patients with autoimmune diseases. An increased risk of mild infections in newborns has been reported, although infections requiring hospitalizations are rare. Data suggest that breastfeeding while taking anti-TNF agents is safe for neonates. Less data exist for the use of other mAbs including anticytokine, anti-integrin, and anti-B-cell agents during pregnancy and postpartum.

Conclusions and relevance: Current evidence suggests that the use of mAbs, particularly anti-TNF agents, is safe in pregnancy and postpartum, without significant adverse effects on the pregnant patient or infant. The benefits of ongoing disease control in pregnant patients result in favorable maternal and neonatal outcomes.

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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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