Anti-TNF Alpha Agents and Breastfeeding

While anti-TNF alpha agents readily cross the placenta and enter the fetal circulation by the second trimester, comparatively miniscule amounts are secreted into human breast milk. Three agents, including infliximab, adalimumab, and certolizumab, have been shown to be expressed in breast milk at concentrations that are unlikely to impact neonatal health. Other agents, such as natalizumab and golimumab, require further investigation. At present, to avoid potential neonatal susceptibility to infection, live virus vaccines (such as rotavirus vaccine) are given after 6 months of life to ensure that antenatally acquired levels of the agents have left the neonate's system. Current knowledge does not suggest added risk from lactational exposure to these agents, so breast-feeding mothers should be encouraged to avoid discontinuation of the anti-TNF alpha agents needed to control their inflammatory bowel disease.