SAT0127 LONG-TERM OUTCOME OF CHILDREN BORN TO MOTHERS WITH CHRONIC ARTHRITIS AND EXPOSED TO TNF-INHIBITORS DURING PREGNANCY: A CASE-CONTROL STUDY
Authors: Maria Chiara Gerardi, Laura Andreoli, Chiara Bazzani, Matteo Filippini, Micaela Fredi, Roberto Gorla, Maria Grazia Lazzaroni, Cecilia Nalli, Marco Taglietti, Andrea Lojacono, Sonia Zatti, Mario Motta, Angela Tincani
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Treatment with tumor necrosis factors inhibitors (TNFi) during pregnancy may be required in order to control maternal disease which itself can be a threat for maternal-fetal well-being and pregnancy outcome. Information about the follow-up of in utero exposed offspring is limited <h3>Objectives</h3> The aim of this study was to compare the health and developmental conditions of children born to mothers with chronic arthritis who were exposed <i>in utero</i> to TNFi with those of unexposed children born to patients with the same age at conception and disease. <h3>Methods</h3> An <i>ad-hoc created</i> questionnaire was used to collect data on birth and growth parameters, breastfeeding, weaning, developmental milestones, vaccinations and illnesses. <h3>Results</h3> 122 live births in 97 women with chronic arthritis (65 RA and 32 SpA) were observed: 59 pregnancies were exposed to TNFi at the time of conception and 63 pregnancies were TNFi-naïve. In 57/59 (97%) pregnancies, TNFi was discontinued at positive pregnancy index. In 2/59 (3%) pregnancies TNFi was mantained throughout pregnancy due to active disease at conception. TNFi was restarted in 16/57 pregnancies (28%) (10 ETA, 5 CTZ, 1 ADA) during the 2<sup>nd</sup>-3<sup>rd</sup> trimester due to moderate-severe flare (median exposure 22 weeks; discontinuation of TNFi between 32-39 gestational weeks). In second group, TNFi (1 ETA, 1 CTZ) was introduced in 2/63 (3%) pregnancies during the 2<sup>nd</sup> trimester due to a severe flare. 16 in 16/63 (25%) pregnancies were managed with an increase of prednisone (max 10mg/day). To investigate the long-term follow-up of children exposed in utero to TNFi, 61 children exposed to TNFi at conception or during 2<sup>nd</sup>-3<sup>rd</sup> trimester (median age 29 months) and 61 unexposed children (median age 49 months) were compared. No significant differences in growth parameters and developmental milestones were observed. No excess nor particular pattern of congenital defects/malformations were observed. In both groups, vaccinations were performed according to the national schedule (no live vaccines in the first year of life) without relevant complications (Figure 1). <h3>Conclusion</h3> TNFi may be required in patients that experienced flare during pregnancy and they are effective in controlling maternal disease and ensures a good pregnancy outcome without complications for the health and growth of exposed children. <h3>Acknowledgement</h3> None <h3>Disclosure of Interests</h3> Maria Chiara Gerardi: None declared, Laura Andreoli: None declared, Chiara Bazzani: None declared, Matteo Filippini: None declared, Micaela Fredi: None declared, Roberto Gorla: None declared, Maria Grazia Lazzaroni: None declared, Cecilia Nalli: None declared, Marco Taglietti: None declared, Andrea Lojacono: None declared, Sonia Zatti: None declared, Mario Motta: None declared, Angela Tincani Consultant for: UCB, Pfizer, Abbvie, BMS, Sanofi, Roche, GSK, AlphaSigma, Lillly, Jannsen, Cellgene, Novartis