Use of Biologics and Immune Checkpoint Inhibitors During Pregnancy in Patients with Systemic Autoimmune Diseases and Cancer

Biologics and immune checkpoint inhibitors have transformed the treatment of autoimmune conditions and cancers. However, safety data regarding use during pregnancy are limited. Clinicians are left to weigh the potential benefits of treatment with frequently unknown risks to the pregnant patient and developing fetus. These therapies do not cross the placenta during the first trimester; thus, they are unlikely to cause teratogenicity. Use later in pregnancy has the potential to immunosuppress the neonate, which could lead to infection and inadequate vaccine response. These large molecules are minimally transferred into breastmilk and are mostly compatible with nursing.