To the Editor: We read with great interest the study by Chaparro et al. in regard to outcomes of infants exposed to anti‐TNF in utero [1]. In their study, they found no increased risk for serious infections in those infants exposed to anti‐TNF agents in utero compared with non‐exposed. However, they did find a higher proportion of complications in terms of cesarean sections, need for ICU admission and low birth weight.
This is important work that adds to our body of knowledge with a large cohort followed for more than just a few weeks. In their analysis the authors found that it was pre‐term birth, and not the use of anti‐TNF therapy that was associated with an increased risk of adverse birth outcomes. These results should be comforting to our patients, who are concerned about the risks of continued biologic exposure during pregnancy.
But as with other large studies on pregnancy to date this study was limited to only singleton pregnancies. As the number of women undergoing assisted reproductive technology (ART) increases, we clinicians get the obvious question: what will happen to my twins? There are known increased risks for both maternal and neonatal outcomes in multiple gestation pregnancies, but hard to counsel anxious patients without data. We do have some recent population‐based data as to the outcomes of twins in the healthy population [2]; future multi‐center experience with multiple gestation pregnancies will be just as important to study as the singleton pregnancies.
CONFLICT OF INTEREST
Guarantor of the article: Sunanda Kane, MD, MSPH.
Specific author contributions: SK: concept of article, writing and review; BB: writing of article and review.
Financial support: None.
Potential competing interests: SK is a consultant to AbbVie, Merck, Samsung Bioepis and UCB. BB declares that she has no conflict of interest.
Footnotes
Correspondence: S.K. (email: kane.sunanda@mayo.edu)
REFERENCES
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