In utero biologic exposure & infant infection risk

Mar 23, 2021 - E-Mentoring in IBD | Volume 14 • 2021

Issue 06

Clinical Question

Does exposure to biologics in utero increase the risk of infant infections?

Editor’s Bottom Line

Biologics administered to women with IBD during pregnancy do not appear to increase their infants’ risk of infection.


Gubatan J, Ole Haagen N, Levitte S, et al. Biologics During Pregnancy in Women with Inflammatory Bowel Disease and Risk of Infantile Infections: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2021;116(2):243–53.


There have been conflicting findings on the risk of infections among infants exposed to biologics in utero. To examine this topic further, American and Danish researchers performed a systematic review and meta-analysis of nine studies published between 2013 and 2019. The studies, of which two were prospective and seven were retrospective, included data from 8,013 women with IBD who gave birth to 8,490 infants, 1,965 of whom were exposed to biologics during pregnancy. Women were a mean 31 years of age at the time of pregnancy. The studied medications included infliximab, adalimumab, certolizumab, golimumab, ustekinumab, vedolizumab and natalizumab.

Results revealed an incidence of 0.27 infections per infant-year among infants exposed to biologics in utero, compared to 0.40 infections per infant-year among infants not exposed to biologics in utero. Statistical analyses showed no overall association between  infantile infections and exposure to biologics in utero (Odds Ratio [OR]: 0.91; 95% Confidence Interval [CI], 0.73–1.14; p=0.43). However, a subgroup analysis found that the risk of upper respiratory infections in particular was increased (OR: 1.57; 95% CI, 1.02–2.40; p=0.04). There was no significant association with acute otitis media, urinary tract infections and gastrointestinal infections. Rates of antibiotic use and infection-related hospitalizations were not significantly higher among infants exposed to biologics in utero. There were no reported infection-related deaths and the risk of infections was not greater among women who continued biologics in their third trimester. The results showed no differences in medication-specific infection risk.


Study Design: Systematic review and meta-analysis

Funding: None

Allocation: None

Setting: Multicenter

Level of Evidence: 2a

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.