TNF Inhibitors Linked to Increased Birthweight in Pregnant Women with RA

by Ella

A recent study published in the Journal of the American Heart Association suggests that treatment with tumor necrosis factor inhibitors (TNF) may contribute to higher birthweights among pregnant patients with rheumatoid arthritis (RA), independently of the soluble Fms‐like tyrosine kinase‐1 (sFlt-1)/placental growth factor (PlGF) ratio.


The investigation, led by Dr. Cornelia H Quaak from the Department of Rheumatology at Erasmus Medical Center Rotterdam in the Netherlands, aimed to elucidate the relationship between sFlt-1 and PlGF levels and birthweight in women undergoing TNF treatment during pregnancy.


PlGF and sFlt-1 serve as biomarkers for placentation and placental function, with an elevated sFlt-1/PlGF ratio often associated with adverse pregnancy outcomes such as fetal growth restriction and preeclampsia.


The study drew data from the Preconception Counseling in Active RA (PreCARA) study, conducted at Erasmus Medical Center. Blood samples were collected from participants across trimesters to analyze sFlt-1 and PlGF levels, comparing outcomes between TNF-treated and untreated groups.


Of the 158 women included in the analysis, approximately 52.5% received TNF treatment during pregnancy. Notably, birthweight was significantly higher in TNF-treated patients compared to those untreated. Moreover, sFlt-1 levels correlated negatively with birthweight among untreated patients, a correlation absent in TNF-treated individuals.

While sFlt-1 and PlGF levels increased during pregnancy, the ratio declined, suggesting a potential role for TNF treatment in mitigating adverse outcomes associated with elevated sFlt-1 levels.

Despite the study’s comprehensive approach and inclusion of a substantial sample size, limitations were noted, including the inability to collect laboratory samples from all patients across trimesters.

The findings underscore the potential therapeutic implications of TNF inhibitors in managing pregnancy-related complications characterized by elevated sFlt-1 levels, such as preeclampsia.

In conclusion, the study sheds light on the complex interplay between TNF treatment, sFlt-1/PlGF ratios, and birthweight in pregnant women with RA, offering valuable insights for future research and clinical practice.


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