Biologics in pregnancy TOG 2016 Flashcards
Which biologic agent does not cross the placenta effectively?
Certolizumab
Common SE and precautions for pregnancy women on biologics
1) Risk infection
- reactivation of latent TB - screen and treat TV
- Up to date vaccines, live vaccines contraindicated once on biologic
2) Risk certain malignancies
- Consider smear
3) Risk immediate hypersensitivity reaction
Which vaccines are live
BCG
MMR
Yellow fever
Oral polio
Rotavirus
Are biologics associated with congenital malformations?
No evidence of increased risk
Should you stop biologicals whilst attempting conception/early pregnancy?
No
Active disease higher risk to pregnancy - PET/FGR/SGA/PTB
What is the main concern of biologics in pregnancy?
Transplacental transfer of biologic, causing immunosuppression in the neonate (although no identified increased risk of infection)
Occurs mostly after 20 weeks, maximal active transfer at 28 weeks.
Which 2 biologics have long very long half lifes - leading to high levels in cord blood?
Adalimumab 10-20 days
Infliximab 8-10 days
98-400% maternal drug levels
When to stop infliximab?
21-22 weeks
To ensure safe levels stop by 16 weeks
When to stop adalimumab?
26-28 weeks
To ensure safe levels stop by 3rd trimester
when to stop etanercept?
30-32 weeks
To ensure safe levels stop by 3rd trimester
Short half life, less levels in cord 3.6-7.4%
When to stop certolizumab?
Sae to continue throughout pregnancy as does not actively cross placenta (only passively)
Half life 14 days, cord blood 1.5-24%
Can women breastfeed whilst taking biologics?
Yes, mostly IgG mediated, IgA passes through breast mild
When should biologics be restarted postpartum
Immediately
Can delay if infection
Infants exposed to anti-TNF in utero should not have what ex-utero?
Should not be immunised with live vaccines - rotavirus and BCG for 6 months of life.
Infants exposed to B-cell depleting agents in late 2nd trimester (rituximab and belimumab), what may be found in the infant?
Transient cytopenias
Absent B lymphocytes
