Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2025;23(1):144-153.e22
Safety of vedolizumab and ustekinumab compared with anti-TNF in pregnant women with inflammatory bowel disease
Background and aims: Limited data are available on the consequences of prenatal exposure to vedolizumab and ustekinumab. The authors aimed to compare the safety of vedolizumab and ustekinumab with that of anti-tumor necrosis factor (anti-TNF) in pregnant women with inflammatory bowel diseases (IBD).
Methods: Using nationwide, comprehensive data of the EPI-MERES registry, the authors identified pregnancies in women with IBD in France, exposed to anti-TNF, vedolizumab, and ustekinumab between 2014 and 2021. Pregnancy outcomes and complications were compared in the offspring according to treatment exposure during pregnancy. A propensity score matching for maternal, IBD, and pregnancy characteristics was applied.
Results: 398 pregnancies exposed to vedolizumab were compared with 1592 pregnancies exposed to anti-TNF; 464 pregnancies exposed to ustekinumab were compared with 1856 pregnancies exposed to anti-TNF. Overall, compared with anti-TNF, neither vedolizumab nor ustekinumab was associated with increased risks of abortion, caesarean section, stillbirth, preterm birth, serious infections, malignancies, or congenital abnormality in children. Women exposed to ustekinumab had an increased risk of small for gestational age births.
Conclusions: Overall, the safety of vedolizumab and ustekinumab compared with anti-tumor necrosis factor use during pregnancy is reassuring. Further studies are needed to confirm these findings.