Updated Systematic Review and Meta-Analysis on Medication Safety During Pregnancy in Inflammatory Bowel Disease

Introduction: This systematic review and meta-analysis aimed to evaluate the safety of current medications for inflammatory bowel disease (IBD) during pregnancy, specifically assessing their impact on early pregnancy loss, low birth weight (LBW), preterm delivery, congenital malformations, and stillbirth. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies. Pooled prevalence rates and relative risks (RR) were calculated using a random-effects model. Quality assessments were performed using appropriate tools. Results: The analysis included multiple studies on the safety of biologics in pregnancy for patients with IBD. The pooled prevalence of early pregnancy loss was 9%, with anti-tumor necrosis factor (anti-TNF) medications showing a prevalence of 8%, ustekinumab (UST) 14%, vedolizumab (VDZ) 18%, and thiopurines (TPR) 11%. The total pooled prevalence of low birth weight was 7%, with anti-TNF medications at 9%, UST at 4%, VDZ at 5%, and TPR at 6%. The prevalence of preterm delivery was 10%, with anti-TNF medications at 9%, UST at 7%, VDZ at 19%, and TPR at 11%. The pooled prevalence of congenital malformations was 3%, with TPR and anti-TNF medications both at 3%. The prevalence of stillbirth was 0.4%, with anti-TNF medications at 0.1% and TPR at 1% (Figure 1, Table 1). Conclusion: The safety of IBD treatments is essential for physicians and providers managing IBD during pregnancy. Our study is comparable with prior meta-analyses showing that biologics safety in IBD is comparable to the general population.Figure 1.: Summary Table of Pregnancy Outcomes with each medication type. Table 1. - Summary of the Pooled Prevalence Statistics Medication Low Birth Weight Congenital Malformations Stillbirth Early Pregnancy Loss Preterm Delivery Anti-TNF 6% (0.04, 0.08) P< 0.05; I2=73% 3% (0.03, 0.04) P< 0.05; I2=35% 0.1% (0.002, 0.02) P< 0.05; I2 77% 8% (0.06, 0.10) P< 0.05; I2=71% 9% (0.07, 0.11) P< 0.05; I2 56% UST 4% (-0.03, 0.11) P=NA; I2=NA 5% (0.02, 0.08) P=0.76; I2= 0% 0.3% (-0.003, 0.009) P=0.72; I2= 0% 14% (0.08, 0.20) P=0.24; I2=31% 7% (0.03, 0.10) P=0.36; I2=0% TPR 6% (0.04, 0.08) P< 0.05; 3% (0.01, 0.05) P< 0.05; I2 67% 1% (0.002, 0.02) P< 0.05; I2=77% 11% (0.07, 0.14) P< 0.05; I2=95% 11% (0.08, 0.14) P< 0.05; I2=84% VDZ 5% (-0.04, 0.14) P=NA; I2 = NA 6% (0.02, 0.10) P=0.76; I2=0% 1% (-0.01, 0.3) P=0.76; I2=0% 18% (0.12, 0.24) P=0.55; I2=0% 19% (0.12, 0.26) P=0.47; I2=0% All 7% (0.05, 0.09) P< 0.05; I2=75% 3% (0.02, 0.08) P< 0.05; I2=42% 0.4% ( 0.002, 0.01) P< 0.05; I2 38% 9% (0.08, 0.11) P< 0.05; I2=86% 10% (0.09, 0.11) P< 0.05; I2=69%