Anti-TNF therapy and pregnancy outcomes in women with inflammatory arthritis

Women suffering from inflammatory arthritis may experience a change in disease activity during and after pregnancy. Although the majority will improve, some women may need to continue therapy throughout pregnancy and/or in the lactation period. Since certain disease-modifying antirheumatic drugs have proven to be human teratogens, treatment is limited in these women. Anti-TNF agents fall within the US FDA category B concerning fetal risk, indicating that no adequate and well-controlled studies have been conducted in pregnant or lactating women. However, in the last decade, numerous case series and case reports of pregnancies exposed to anti-TNF therapy have accumulated in the literature. Since these agents may constitute an important therapeutic alternative in pregnant women facing persistent or increased disease activity, we propose a review of the available information on the safety of anti-TNF agents in pregnancy and lactation.