Infliximab

Print
Date: November 2022, Version 4.2

Quick read

Infliximab 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?

Infliximab (Remsima®, Flixabi®, Inflectra®, Remicade®, Zessly®) dampens the immune response. It is used to treat some autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, Crohn’s disease, and ulcerative colitis.

Benefits

What are the benefits of using infliximab in pregnancy?

Infliximab helps to stop the immune system from attacking the body. It controls the unpleasant and often disabling symptoms of some autoimmune diseases and helps to prevent ongoing damage to tissues and organs.

Risks

What are the risks of using infliximab in pregnancy?

The available data suggests that infliximab is unlikely to affect the baby’s development. There are reports of some babies being born with a low infant birth weight following infliximab exposure. However, it is unclear if this is caused by the drug itself or the underlying illnesses in pregnant women taking infliximab.

Infliximab used in later pregnancy can potentially affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby cannot be vaccinated against rotavirus (as this needs to be completed by four months) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.

Alternatives

Are there any alternatives to using infliximab in pregnancy?

Possibly. Other immunosuppressant medicines can be used in pregnancy so switching to a different drug may be an option. Some women may also find that their illness improves by itself as pregnancy progresses and so a specialist may advise that treatment can be reduced.

Women on infliximab who are planning a pregnancy or who accidentally conceive should arrange to see their doctor or specialist as soon as possible. This is to check whether infliximab is still the best treatment and to make sure the dose is correct.

No treatment

What if I prefer not to take medicines during pregnancy?

Pregnant women who have poorly controlled autoimmune disease may be at risk of adverse pregnancy outcomes, including miscarriage, preterm delivery, and low infant birth weight. To help reduce the chance of these outcomes and to stop an autoimmune disease from flaring, some women will be advised to continue taking infliximab in pregnancy. A doctor will only prescribe medicines when necessary and will be happy to talk through any concerns.

Will I or my baby need extra monitoring?

As part of routine antenatal care, most women will be offered a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. Women taking infliximab may be offered extra monitoring of the baby’s growth.

Are there any risks to my baby if the father has used infliximab?

There is currently no evidence that infliximab 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 (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. 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 the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.

Feedback