Infliximab infusions in pregnancy

[Amand34]

I have ulcerative colitis and am about to start infliximab infusions.
I was hoping to start trying for a baby this year and I’ve been reading up on how this can effect baby / what it would mean taking this drug during pregnancy.

has anyone been on this whilst pregnant and can give me any guidance? I do have a few questions so please comment if you have experience and are happy to answer them.

thank you

I’m an obstetrician with an interest in managing IBD and have lots of patients on this.
The most important thing is to get the UC under control. As a very broad generalisation, the majority of risks associated with pregnancy (blood clots, growth restriction, premature labour) are much worse with uncontrolled disease. It is very common for symptoms to improve during pregnancy as you are relatively immunosuppressed, and the high risk period is post natally.

People were very cautious about using MAb in pregnancy and it used to be a routine recommendation to not use them after 28 weeks. We are using them in more and more women BUT advise avoiding live vaccines in your baby for the first 6 months of life. In the UK this means no Rotavirus vaccination (it can’t be deferred) and BCG vaccination (not offered to everyone)is done after 6 months.

I would be guided by your gastro team as to what they think the best treatment is for you and make sure you are taking folic acid 5 mg from your GP before trying to get pregnant.
You would be recommended to take aspirin 150mg at night from 12 weeks (the risk of it worsening your IBD is much less than the benefit of reducing fetal growth restriction) and be offered extra growth scans.

FOr some reason I can’t link to the info sheet but google UKTIS infliximab

@khaa2091 thanks so much for your reply.

them not being able to have live vaccines is this because the inflximab weakens their immune system? Are they therefore more susceptible to infections too?
do you know anything about BF whilst on the infusions? I BF my first baby for a year and wanted to do the same next time x

Breast feeding is fine.
There is a theoretical risk of a weakened immune system in your baby, hence the extremely cautious advice to avoid live vaccines, but in practice this does not seem to be a problem. When you compare infections in these babies, they do not seem to occur more often.

@khaa2091 thank you for taking the time to reply, I really appreciate it. That’s all reassuring and what I needed to hear x

Hi, I’ve stayed on Infliximab for all 3 of my pregnancies, although I don’t take it for UC.

I breastfed all 3 DC. Their live vaccines were delayed until 12 months, but touch wood we’ve been very fortunate with infections etc. Barely an antibiotic between them!

Happy to answer any questions and wishing you all the best!