Millie Long, MD: Infectious Complications in Babies Born to Mothers With IBD

In an interview with MD Magazine®, Millie Long, MD, MPH, FACG, associate professor of medicine at the University of North Carolina, Chapel Hill, talks about the Pregnancy in IBD and Neonatal Outcomes (PIANO) registry poster presented at ACG 2019.

MD Magazine: What was the motivation behind the poster you’re presenting at ACG 2019 on use of day care and infectious complications in children born to mothers with inflammatory bowel disease?

Long: So we are presenting a poster here on outcomes for babies born to mothers who have used biologic agents during the course of their pregnancy who haven't inflammatory bowel disease.

These data are from a very important cohort study called the piano cohort study, the pregnancy and IBD and neonatal outcomes study. The principal investigator on this study is Uma Mahadevan, from University of California, San Francisco.

And for over a decade, Uuma has followed mothers and their babies with inflammatory bowel disease to help us to understand outcomes and the effects of some of our medications on those outcomes.

And I've been a part of this project and I've really loved enrolling my patients in it and it's just been a pleasure to work on.

And what has motivated this particular study is that I've actually had so many moms who have asked this question, they may be on a biologic agent and they have concerns for their children about going to daycare.

You know, daycare is associated with we know increased infections complications. In the first year of life, babies can have more diarrhea, more respiratory kind of illnesses.

But typically after that, it kind of all becomes even. And these aren't necessarily serious infections. But is that different for babies who've been exposed to biologics during the course of their pregnancy?

Interestingly, I was in Europe a few years ago, at a presentation. And in Europe, some guidance suggests that women might should not have their children go to daycare due to these unknown information, but that really impacts women. I mean, it's our it's our lives, our livelihood, and we often do need to have our children go to daycare.

And so I thought it would be very important to try to better understand those risks for those children. And so in this cohort, we asked moms about whether or not children were exposed to daycare or other kind of school settings where there were multiple children during the first year of life.

And we were able to look specifically at moms on biologic medications. The reason this is important is those biologic medications, these IGG-based medications actually cross into the placenta during the third trimester.

So babies born to moms on biologics actually often have a level of a biologic in their system. Typically, by about 6 months, that level is gone.

And at this point, what is wonderful news is that we have not seen any congenital malformations, any issues for babies, appropriate vaccine responses, but what was unknown is when you throw a daycare in the mix. Do those babies then have increased infectious complications? And I think what is incredibly important about this study is that there was no increased risk of serious complications, serious infections.

So these babies did not land in the hospital with infections to a greater extent. We did see overall and the daycare popular as compared to the non daycare population that there were slightly increased respiratory and GI illnesses, but that's what's also seen in the general population.

So I think this data are incredibly important for moms who are trying to select a safe, appropriate method of child control childcare, and that this really should be a good option and that we don't see any negative influences specifically associated with biologic exposure in regards to serious infection.