Use of certolizumab in pregnancy
(Date: March 2023. Version: 2.1)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by the UK Health Security Agency (UKHSA) on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
Quick read
Certolizumab can be used in pregnancy to treat inflammatory illnesses. Babies who were exposed in later pregnancy might be offered some of their vaccinations at a later time than usual.
What is it?
Certolizumab (Cimzia®) is an antibody therapy used to treat inflammatory illnesses, including psoriasis and certain types of arthritis.
What are the benefits of using certolizumab in pregnancy?
Certolizumab reduces inflammation by stopping the immune system from attacking the body’s tissues. This is important to reduce unpleasant symptoms and prevent long-term damage. It may also lower the chance of some pregnancy problems linked to uncontrolled inflammation, including miscarriage and lower infant birth weight. Certolizumab does not easily cross the placenta so only tiny amounts reach the baby. It is therefore not expected to cause problems in pregnancy.
What are the risks of using certolizumab in pregnancy?
There are no known risks. Use of certolizumab has been studied in around 1,400 pregnant women and there is no evidence that it affects the baby’s development.
Antibody treatments that work in the same way as certolizumab, but that cross the placenta easily, can affect the baby’s immune system for several months after birth. Babies exposed to these medicines in later pregnancy are not usually given live vaccines (rotavirus or BCG) until the effect on their immune system is likely to have worn off. This reduces the risk of vaccine complications. Although certolizumab does not easily cross the placenta, as a precaution, babies exposed in the womb might be offered live vaccinations at a later time than usual. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.
Are there any alternatives to using certolizumab in pregnancy?
Possibly. Other medicines can be used to treat inflammatory conditions during pregnancy, although these may not work as well as certolizumab. As certolizumab does not easily cross the placenta, staying on it during pregnancy may be the best option.
Women who are planning a pregnancy should speak to their specialist to determine which medicine is best. This can be arranged through the GP or specialist clinic.
If a woman becomes pregnant while taking certolizumab she should be reviewed by her doctor as soon as possible.
What if I prefer not to take medicines during pregnancy?
It is important that inflammatory conditions are well-treated during pregnancy in order to avoid a flare-up of symptoms and to reduce the chance of certain pregnancy complications. A doctor will be happy to discuss any concerns.
Will my baby need extra monitoring?
As part of routine antenatal care in the UK, women are invited for a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. No further scans to check for birth defects will be required, although extra growth scans may be offered.
Are there any risks to my baby if the father has used certolizumab?
There is currently no evidence that certolizumab used by the father can harm the baby through effects on the sperm.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org
How can I help to improve drug safety information for pregnant women in the future?
Our online reporting system allows women with a current or previous pregnancy to create a digitally secure ‘my bumps record’. You will be asked to enter information about your health, whether or not you take any medicines, and your pregnancy outcome. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit https://www.medicinesinpregnancy.org/Login/ to register.
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General information
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.
www.medicinesinpregnancy.org