Tumor necrosis factor-α inhibitor therapy and fetal risk: A systematic literature review

Table 2 Summary of anti-tumor necrosis factor exposures and birth outcomes n (%)

Anti-TNF exposure	Birth outcomes, n (with relative percents)
	Fetal exposures	Live births	SA	SB	PTB/ PMB	LBW/SGA	CA
IFX/ADA/CTZ total	472	405 (85.8)	32 (8.2)	2 (0.6)	41 (19.9)	8 (6.1)	19 (4.1)
IFX1	194	155 (79.9)	15 (10.6)	2 (1.1)	21 (26.9)	5 (4.4)	6 (4.0)
IFX in IBD2	151	117 (77.5)	11 (8.9)	2 (1.4)	16 (36.4)	5 (4.8)	4 (3.5)
ADA1	261	242 (92.7)	16 (6.9)	0 (0.0)	20 (15.9)	2 (28.6)	13 (5.4)
ADA in IBD2	224	210 (93.8)	13 (5.8)	0 (0.0)	15 (17.0)	2 (28.6)	12 (5.7)
CTZ1	17	8 (47.1)	1 (5.9)	0 (0.0)	0 (0.0)	1 (12.5)	0 (0.0)
CTZ in IBD2	17	8 (47.1)	1 (5.9)	0 (0.0)	0 (0.0)	1 (12.5)	0 (0.0)
Outcome percents in general US population[69-73]		64.60%	16.50%	0.60%	12.30%	8.20%	3.00%-5.00%

¹Exposure in all reported medical conditions;

²Exposure in inflammatory bowel disease (IBD) patients. TNF: Tumor necrosis factor; IFX: Infliximab; ADA: Adalimumab; CTZ: Certolizumab pegol; SA: Spontaneous abortion (fetal death at < 20 wk); SB: Stillbirth (fetal death at > 20 wk or > 350 g if gestational age unknown); PTB: Preterm birth (< 37 wk gestation); PMB: Premature birth (< 37 wk gestation and prior to completion of organ development); LBW: Low birth weight (< 2500 g); SGA: Small for gestational age (smaller than average size given number of pregnancy weeks).