#3-47E. Timing Matters: TNFi Exposure and Serious Infections in Offspring (Arthritis Rheumatol, 2026)

For physicians managing pregnant patients with chronic inflammatory diseases like rheumatoid arthritis or IBD, balancing maternal disease control with fetal safety is a constant challenge. A recent retrospective cohort study utilizing the US MarketScan database (2011–2021) addresses this by examining the risk of serious infections in the first year of life among offspring exposed to Tumor Necrosis Factor inhibitors (TNFi) in utero. While the overall analysis of over 3,700 exposed infants revealed no statistically significant increase in infection risk compared to unexposed controls (HR 0.85), the study uncovers critical nuance regarding exposure timing. The most significant clinical insight is that third-trimester exposure was associated with a 70% higher risk of serious infections compared to exposure limited to early pregnancy, with a similar trend observed for agents with high placental transfer ability. However, critical appraisal is necessary; as an observational study using claims data, residual confounding by maternal disease severity remains a limitation, and the wide confidence intervals indicate statistical imprecision. Despite these limitations, this research is vital for clinicians, suggesting that when feasible, minimizing third-trimester exposure or selecting agents with low placental transfer could optimize neonatal outcomes.

Citation: Flatman LK, et al. Serious Infections in Offspring Exposed to Tumor Necrosis Factor Inhibitors During Pregnancy: Comparison of Timing During Pregnancy and Placental Transfer Ability. Arthritis & Rheumatology. 2026. DOI: 10.1002/art.70000

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