Pregnancy and Adalimumab Use

Introduction to Adalimumab Use in Pregnancy

The American College of Rheumatology recommends continuing TNF inhibitors, including adalimumab, during pregnancy, especially in the first and second trimesters, to minimize disease activity 1

Continuing adalimumab during pregnancy is recommended by the American College of Rheumatology, as it is safe and effective in controlling disease activity, with consideration for discontinuation in the third trimester based on disease control 1
Adalimumab crosses the placenta significantly during the third trimester, resulting in high drug levels in the neonate, and should be discontinued if the patient's disease is well-controlled to minimize fetal exposure 1
Untreated active disease may pose greater risks than continuing medication during pregnancy, and continuing adalimumab through delivery can be considered if active disease is present, understanding that the neonate will have significant serum levels of the drug 1

Adalimumab is considered compatible with breastfeeding, according to the American College of Rheumatology, and the benefits of breastfeeding and infant development should be weighed against the clinical need for the mother's treatment 1

If adalimumab is administered after 20 weeks of gestation, the newborn should not receive live vaccines during the first 6 months due to immunosuppression, and consultation with a pediatrician is recommended to determine the vaccination schedule for the newborn 1, 2

The American College of Rheumatology recommends pre-conception planning, including continuing adalimumab while trying to conceive and aiming for disease remission before conception 1
Certolizumab, which has minimal placental transfer, may be considered as an alternative in selected cases where there is concern about intrauterine exposure 1, 3
Infliximab, etanercept, and golimumab have similar safety profiles to adalimumab during pregnancy 1
For inflammatory bowel disease (IBD), maintaining remission during pregnancy is essential for both maternal and fetal outcomes, and adalimumab can be safely continued during pregnancy, particularly in the first and second trimesters 2