Grant: Operating Grant: ECI grants in Maternal, Reproductive, Child & Youth Health

Tumour necrosis factor inhibitors (TNFi) are important drugs in the treatment of pregnant women with chronic inflammatory diseases. Despite existing concerns that these potent drugs may cause immunosuppression, there are limited data on the risk of infections in exposed pregnant women and their offspring. The goal of our research project is to assess the risk of serious infections associated with TNFi in pregnant women and their offspring. We will use data from a large United States administrative database to identify pregnant women with chronic inflammatory diseases for which TNFi are indicated (i.e. rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, inflammatory bowel diseases). We will assess the risk of serious infections during pregnancy and the postpartum period (i.e. the period after delivery) in mothers exposed to TNFi compared to unexposed mothers with chronic inflammatory diseases. We will link mothers exposed to TNFi with their offspring. In these children, we will assess the risk of serious infections occurring during the first year of life, as well as the risk of hospitalizations and/or outpatient visits for diarrhea according to rotavirus vaccine exposure. Our study results will help guide counselling, monitoring, and management of pregnant women requiring TNFi during pregnancy to minimize infectious complications. Our research project will provide much-needed data to help inform best practice guidelines. Ultimately, our findings will help optimize reproductive outcomes in chronic inflammatory diseases and improve the health of offspring, while reducing the burden of infections in this susceptible population.