{"id":2103,"date":"2018-10-20T18:40:28","date_gmt":"2018-10-20T16:40:28","guid":{"rendered":"https:\/\/angh.net\/abstracts\/allaitement-et-vaccination-par-vaccins-vivants-chez-des-nouveau-nes-exposes-in-utero-aux-anti-tnf-etude-nationale-multicentrique\/"},"modified":"2018-11-29T10:52:05","modified_gmt":"2018-11-29T09:52:05","slug":"allaitement-et-vaccination-par-vaccins-vivants-chez-des-nouveau-nes-exposes-in-utero-aux-anti-tnf-etude-nationale-multicentrique","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/allaitement-et-vaccination-par-vaccins-vivants-chez-des-nouveau-nes-exposes-in-utero-aux-anti-tnf-etude-nationale-multicentrique\/","title":{"rendered":"Allaitement et vaccination par vaccins vivants chez des nouveau-n\u00e9s expos\u00e9s in-utero aux anti-TNF\u03b1 : \u00e9tude nationale multicentrique"},"content":{"rendered":"

2018<\/strong><\/p>\n

Sihem Bendaoud (Rosny-sous-Bois, FRANCE), St\u00e9phane Nahon (Montfermeil, FRANCE), Morgane
\nAmil (La Roche-sur-Yon, FRANCE), Isabelle Rosa (Cr\u00e9teil, FRANCE), Fr\u00e9d\u00e9ric Heluwaert (Annecy,
\nFRANCE), Laurianne Plastaras (Colmar, FRANCE), Carmen Stefanescu (Clichy-la-Garenne, FRANCE),
\nVincent Quantin (Saint-Brieuc, FRANCE), Michel Antoni (Orange, FRANCE), Karine Bideau (Quimper,
\nFRANCE), M\u00e9dina Boualit (Lille, FRANCE), Alexandre Aubourg (Tours, FRANCE), Jean-Marc Gornet
\n(Paris, FRANCE), E Cuillerier (Dreux, FRANCE), Christophe Locher (Meaux, FRANCE), Florence
\nSkinazi (Paris, FRANCE), Marion Simon (Paris, FRANCE), Arnaud Bourreille (Nantes, FRANCE),
\nBenjamin Pariente (Lille, FRANCE), Laurent Beaugerie (Paris, FRANCE), Laurent Peyrin-Biroulet
\n(Vandoeuvre-l\u00e8s-Nancy, FRANCE), Xavier H\u00e9buterne (Nice, FRANCE), Anthony Buisson (Clermont-
\nFerrand, FRANCE), Vered Abitbol (Paris, FRANCE), Romain Altwegg (Montpellier, FRANCE)<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02018-05-11 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction
\nLes anti-TNF sont le plus souvent maintenus pendant la grossesse chez les patientes attteintes
\nde maladie inflammatoire chronique de l’intestin (MICI). Le consensus ECCO 2015 pr\u00e9conise leur
\narr\u00eat apr\u00e8s la 24-26\u00e8me semaine d\u2019am\u00e9norrh\u00e9e (SA), si possible, en raison de leur passage transplacentaire.
\nL’administration de vaccins vivants doit \u00eatre diff\u00e9r\u00e9e au-del\u00e0 du 6\u00e8me mois de vie
\nchez les nourrissons dont la m\u00e8re a re\u00e7u des anti-TNF pendant la grossesse. Il y a peu de donn\u00e9es
\nsur l’allaitement sous Anti-TNF. L\u2019objectif de cette l\u2019\u00e9tude est d\u2019\u00e9tablir le taux et la tol\u00e9rance de 1)
\nla vaccination par vaccins vivants avant et apr\u00e8s 6 mois de vie chez des nouveau-n\u00e9s expos\u00e9s in
\nutero aux Anti TNF et 2) de l\u2019allaitement sous Anti TNF.
\nPatients et M\u00e9thodes
\nEtude Fran\u00e7aise r\u00e9trospective et observationnelle multicentrique dans les centres du GETAID et de
\nl\u2019ANGH. Inclusion par des gastroent\u00e9rologues dans une base de donn\u00e9es informatis\u00e9e,
\nanonymis\u00e9e, apr\u00e8s consentement de patientes enceintes atteintes de MICI sous Anti-TNF,
\ndonnant naissance \u00e0 un enfant vivant et r\u00e9pondant \u00e0 un questionnaire sur 1)la vaccination de leur
\nnourrisson par vaccins vivants (BCG-ROR et Rotavirus) avant et apr\u00e8s 6 mois de vie,
\n2)l\u2019allaitement au cours de la premi\u00e8re ann\u00e9e de vie, 3)les modalit\u00e9s d\u2019informations durant la
\ngrossesse.
\nR\u00e9sultats
\nDe f\u00e9vrier 2016 \u00e0 septembre 2017, 143 patientes enceintes (113 maladies de Crohn et 30
\nrectocolite h\u00e9morragiques), trait\u00e9es par Anti TNF ont \u00e9t\u00e9 incluses dans 28 centres hospitaliers.
\nL\u2019\u00e2ge moyen des patientes \u00e9tait de 31.5 ans (IQR 5). L\u2019Anti TNF administr\u00e9 \u00e9tait : l\u2019infliximab (n=
\n86, 60%), l\u2019adalimumab (n=53, 37%), le certolizumab (n= 3, 2%) et le golimumab (n=1). Les
\nThiopurines \u00e9taient associ\u00e9es chez 30 (21%) patientes. 35 (24.5%) femmes ont pr\u00e9sent\u00e9 une
\npouss\u00e9e de la maladie durant la grossesse, dont 20 n\u00e9cessitant une corticoth\u00e9rapie. . L’Anti-TNF
\n\u00e9tait interrompu avant 24-26 SA chez 74 (58%) patientes et repris ou poursuivi apr\u00e8s
\nl\u2019accouchement chez 131 (92%) patientes. 65 (46%) femmes ont accouch\u00e9 dans une maternit\u00e9
\nniveau 3 . Soixante-trois (45%) patientes ont allait\u00e9. Aucune complication n’a \u00e9t\u00e9 constat\u00e9e.
\nParmi les patientes n’ayant pas allait\u00e9, 49 ne l’ont pas fait par choix personnel, 27 apr\u00e8s conseil du
\ngastroent\u00e9rologue. Concernant le questionnaire sur la vaccination, 120 r\u00e9ponses \u00e9taient obtenues.
\nLe BCG \u00e9tait r\u00e9alis\u00e9 chez 33 (27.5%) nourrissons dont 19 (16%) avant 6 mois. Un abc\u00e8s local
\nd\u2019\u00e9volution favorable et une inflammation locale \u00e9voluant pendant un an ont \u00e9t\u00e9 observ\u00e9s.
\nSoixante-douze (60%) nourrissons \u00e9taient vaccin\u00e9s contre le ROR, dont 6 avant 6 mois sans
\ncomplications. Sept (6%) nourrissons \u00e9taient vaccin\u00e9s contre le Rotavirus, dont 5 avant 6 mois
\net sans complication. L\u2019information concernant l\u2019allaitement et la vaccination a \u00e9t\u00e9 donn\u00e9e \u00e0 127
\n(89%) patientes, principalement par le gastroent\u00e9rologue n= 123 (86%), par l\u2019obst\u00e9tricien 23%, le
\np\u00e9diatre de la maternit\u00e9 16% et par le p\u00e9diatre de ville 12%. L\u2019information a \u00e9t\u00e9 donn\u00e9e
\noralement chez 120 (84%) patientes et par support \u00e9crit chez 44 (31%).
\nConclusion
\nDans cette \u00e9tude observationnelle, la moiti\u00e9 des femmes expos\u00e9es aux Anti-TNF ont allait\u00e9 sans
\ncomplications. 27% des nouveaux-n\u00e9s sont vaccin\u00e9s contre le BCG, parmi lesquels plus de la
\nmoiti\u00e9 avant 6 mois et sans complication grave. La vaccination contre le rotavirus est rare, le plus
\nsouvent faite avant 6 mois et sans complications graves. La majorit\u00e9 des patientes enceintes
\navec MICI, re\u00e7oivent les informations relatives aux Anti-TNF pendant la grossesse par leur
\ngastroent\u00e9rologue. L’information par les obst\u00e9triciens et les p\u00e9diatres doit etre am\u00e9lior\u00e9e.<\/p>\n[download id=\u00a0\u00bb2203″]\n","protected":false},"excerpt":{"rendered":"

2018 Sihem Bendaoud (Rosny-sous-Bois, FRANCE), St\u00e9phane Nahon (Montfermeil, FRANCE), Morgane Amil (La Roche-sur-Yon, FRANCE), Isabelle Rosa (Cr\u00e9teil, FRANCE), Fr\u00e9d\u00e9ric Heluwaert (Annecy, FRANCE), Laurianne Plastaras (Colmar, FRANCE), Carmen Stefanescu (Clichy-la-Garenne, FRANCE), Vincent Quantin (Saint-Brieuc, FRANCE), Michel Antoni (Orange, FRANCE), Karine Bideau (Quimper, FRANCE), M\u00e9dina Boualit (Lille, FRANCE), Alexandre Aubourg (Tours, FRANCE), Jean-Marc Gornet (Paris, FRANCE), E […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[29],"class_list":["post-2103","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-29"],"yoast_head":"\nAllaitement et vaccination par vaccins vivants chez des nouveau-n\u00e9s expos\u00e9s in-utero aux anti-TNF\u03b1 : \u00e9tude nationale multicentrique - 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