TY - JOUR T1 - Live vaccinations for infants exposed to maternal infliximab in utero and via breast milk – the need for nuanced decision making JF - BMJ Open Gastroenterology JO - BMJ Open Gastro DO - 10.1136/bmjgast-2022-001029 VL - 9 IS - 1 SP - e001029 AU - Christian Philipp Selinger AU - Klaartje Bel Kok AU - Jimmy K Limdi AU - Alexandra Kent AU - Rachel Cooney AU - Catherine Nelson-Piercy Y1 - 2022/10/01 UR - http://bmjopengastro.bmj.com//content/9/1/e001029.abstract N2 - Infant health outcomes are a key consideration in decisions regarding therapy for pregnant and breast-feeding women with inflammatory bowel disease (IBD). A recent study by Kanis et al reported outcomes from 1000 children born to mothers with IBD (196 exposed to anti-TNFs) with no increased risk of adverse outcomes associated with anti-TNF exposure.1 Anti-TNF therapy should be continued through all trimesters to avoid maternal flares and consequent adverse fetal outcomes.2 3 Discontinuation in the third trimester is not associated with a decrease in infant infection risks.2 As the infant will be exposed to anti-TNF by active placental transfer, live vaccinations for the infant should be delayed to avoid potentially fatal infant outcomes.3The Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA) have recently issued guidance for infants exposed to Infliximab in utero and by breast feeding.4 They recommend that infants exposed to Infliximab in utero should not receive live vaccinations until 12 months of age.4 As clearance of Infliximab from the infant’s blood stream occurs after a … ER -