Skip to main content
SMFM 2026 Pregnancy Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared outside of the session
Faculty have requested this content not be shared outside of the session
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
Poster Icons
Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 2

Category: Epidemiology

Poster Session 2

(683) Obstetrical Outcomes Following Preconception to Early Second Trimester Tumor Necrosis Factor-Alpha Inhibitor Use

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  
Objective:
There is conflicting evidence for pregnancy outcomes associated with TNF-α inhibitor (TNFαi) use among women with autoimmune indications, limiting guidance to this high-risk population. We aimed to characterize adverse pregnancy outcomes for TNFαi use from preconception to early second trimester.

Study Design:
The TriNetX U.S Collaborative Network was queried for deliveries from 11/6/2012- 12/3/2024 among psoriasis, inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or juvenile arthritis patients. TNFαi group was defined as having ≥ 1 prescription of etanercept, adalimumab, infliximab, certolizumab, or golimumab during 1-year preconception to early second trimester. We defined two controls: 1) non-users; 2) active comparator users (hydroxychloroquine, sulfasalazine, azathioprine, mesalamine). TNFαi and controls were 1:1 propensity score matched (PSM) on demographics, comorbidities, healthcare use, BMI, and medications. Index exposure date was gestational age 18-24 weeks (ICD-10 codes Z3A.18-24). Hazard ratios (HR) and 95% confidence intervals (CI) of outcomes including preeclampsia, eclampsia, small & large for gestational age infant, stillbirth, gestational diabetes, placental abruption, cesarean section, ante-, intra-, and postpartum hemorrhage, preterm premature rupture of membranes, venous thromboembolism, oligohydramnios, chorioamnionitis, and major adverse cardiovascular events (MACE), were calculated with cox proportional hazards model. The groups were followed up from index date until 1) outcome; 2) loss to follow-up; 3) 6 months.

Results:
1,667 TNFαi users were PSM-matched to non-users, and 1,165 to active comparators. TNFαi use significantly reduced risk of placental abruption (HR 0.49, 95% CI 0.28-0.84) and MACE (HR 0.42, 95% CI 0.21-0.85), but not other outcomes compared to non-users. No differences in any outcomes were found between TNFαi users and active comparators.

Conclusion:
Preconception to early second trimester TNFαi use was not associated with adverse pregnancy outcome risks, supporting obstetric safety profile.