{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:19:41Z","timestamp":1792718381922,"version":"4.5.0"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250372-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Continuation of biologics in patients with an autoimmune condition who become pregnant involves weighing consequences of pregnancy-related changes in disease severity and potential teratogenic effects of medications. Characterization of biologic treatment patterns during pregnancy may provide insight into maternal and fetal risks and benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the utilization pattern of biologics in pregnant individuals with autoimmune conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study used data from Merative MarketScan Research Databases, which contain administrative claims of commercially insured individuals in the US. Pregnant patients aged 16 to 55 years with an autoimmune condition and biologic use 6 months before conception between January 1, 2011, and December 31, 2022, were included. The data were analyzed between October 15, 2024, and February 28, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Use of biologics for autoimmune disease after conception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The proportion of patients who used biologics for Crohn disease, ulcerative colitis, psoriasis or psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and multiple sclerosis was assessed, and the association between underlying autoimmune disease and use of biologics during pregnancy was measured using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of  6131 pregnant patients (median [IQR] age, 32 [29-36] years) with an autoimmune condition were included. The most prevalent conditions were Crohn disease\u2009(1372 patients [25.6%]) and rheumatoid arthritis\u2009(1295\u2009patients [24.1%]). Of all patients, 4393 (71.6%; 95% CI,\u200970.5%-72.8%) used biologics at least once during pregnancy. Among pregnancies with live birth outcomes, biologic use declined throughout gestation, with 2981 patients (68.6% [95% CI,\u200967.2%-70.0%]), 2555 patients (58.8% [95% CI,\u200957.3%-60.3%]), and 2113 patients (48.6% [95% CI,\u200947.1%-50.1%]) using biologics during the first, second, and third trimesters, respectively, and 3350 patients (77.1% [95% CI, 75.8%-78.3%]) using them post partum. Compared with pregnant patients with rheumatoid arthritis, those with Crohn disease (odds ratio [OR],\u20097.88 [95% CI, 5.93-10.47]) and ulcerative colitis (OR,\u20095.35 [95% CI, 3.73-7.66]) were more likely to use biologics, while those with psoriasis or psoriatic arthritis (OR,\u20090.65 [95% CI, 0.52-0.80]) were less likely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250372-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, a decline in the use of biologics for autoimmune disease was observed during the pregnancy period that rebounded only partially thereafter. Notable variations in use across autoimmune conditions suggest that indication-specific risk-benefit assessments of biologic use are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.10504","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T11:01:15Z","timestamp":1747306875000},"page":"e2510504","source":"Crossref","is-referenced-by-count":15,"title":["Use of Biologics During Pregnancy Among Patients With Autoimmune Conditions"],"prefix":"10.1001","volume":"8","author":[{"given":"Celeste L. Y.","family":"Ewig","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanning","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Smolinski","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy Nhu","family":"Thai","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja A.","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"issue":"17","key":"zoi250372r1","doi-asserted-by":"publisher","first-page":"3229","DOI":"10.1080\/14767058.2020.1817893","article-title":"Prevalence of autoimmune disease among pregnant women and women of reproductive age in New South Wales, Australia: a population-based study.","volume":"35","author":"Nielsen","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"3","key":"zoi250372r2","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/1753495X20964680","article-title":"Prevalence of autoimmune conditions in pregnant women in a tertiary maternity hospital: a cross-sectional survey and maternity database review.","volume":"14","author":"Lim","year":"2021","journal-title":"Obstet Med"},{"issue":"9","key":"zoi250372r3","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1002\/ajmg.a.36625","article-title":"Maternal exposure to methotrexate and birth defects: a population-based study.","volume":"164A","author":"Dawson","year":"2014","journal-title":"Am J Med Genet A"},{"issue":"3","key":"zoi250372r4","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1002\/ajmg.a.35223","article-title":"Teratogenicity of mycophenolate confirmed in a prospective study of the European Network of Teratology Information Services.","volume":"158A","author":"Hoeltzenbein","year":"2012","journal-title":"Am J Med Genet A"},{"issue":"4","key":"zoi250372r5","doi-asserted-by":"publisher","first-page":"e48","DOI":"10.1093\/rheumatology\/keac551","article-title":"British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids.","volume":"62","author":"Russell","year":"2023","journal-title":"Rheumatology (Oxford)"},{"issue":"8","key":"zoi250372r6","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.3899\/jrheum.140583","article-title":"Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project.","volume":"42","author":"Bharti","year":"2015","journal-title":"J Rheumatol"},{"issue":"6","key":"zoi250372r7","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1097\/MIB.0000000000000060","article-title":"Birth outcomes in women with inflammatory bowel disease: effects of disease activity and drug exposure.","volume":"20","author":"Br\u00f6ms","year":"2014","journal-title":"Inflamm Bowel Dis"},{"issue":"8","key":"zoi250372r8","doi-asserted-by":"publisher","first-page":"809","DOI":"10.18553\/jmcp.2017.23.8.809","article-title":"Temporal trends in use of biologic DMARDs for rheumatoid arthritis in the United States: a cohort study of publicly and privately insured patients.","volume":"23","author":"Desai","year":"2017","journal-title":"J Manag Care Spec Pharm"},{"issue":"7","key":"zoi250372r9","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/j.cgh.2017.01.035","article-title":"Temporal trends in initiation of therapy with tumor necrosis factor antagonists for patients with inflammatory bowel disease: a population-based analysis.","volume":"15","author":"Targownik","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"9","key":"zoi250372r10","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1093\/ibd\/izaa294","article-title":"The patterns of use of medications for inflammatory bowel disease during pregnancy in the US and Sweden are changing.","volume":"27","author":"Br\u00f6ms","year":"2021","journal-title":"Inflamm Bowel Dis"},{"issue":"5","key":"zoi250372r11","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1002\/acr.20422","article-title":"Patterns of medication use during pregnancy in rheumatoid arthritis.","volume":"63","author":"Kuriya","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"7","key":"zoi250372r12","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1002\/acr.23434","article-title":"Patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases: a population-based cohort study.","volume":"70","author":"Tsao","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"11","key":"zoi250372r13","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1038\/s41395-018-0176-7","article-title":"Continuous anti-TNFa use throughout pregnancy: possible complications for the mother but not for the fetus. a retrospective cohort on the French National Health Insurance Database (EVASION).","volume":"113","author":"Luu","year":"2018","journal-title":"Am J Gastroenterol"},{"issue":"10","key":"zoi250372r14","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.7326\/M22-0819","article-title":"Benefits and risks associated with continuation of anti-tumor necrosis factor after 24 weeks of pregnancy in women with inflammatory bowel disease: a nationwide emulation trial.","volume":"175","author":"Meyer","year":"2022","journal-title":"Ann Intern Med"},{"issue":"8","key":"zoi250372r15","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1093\/rheumatology\/keaa064","article-title":"Maternal and neonatal outcomes associated with biologic exposure before and during pregnancy in women with inflammatory systemic diseases: a systematic review and meta-analysis of observational studies.","volume":"59","author":"Tsao","year":"2020","journal-title":"Rheumatology (Oxford)"},{"issue":"6","key":"zoi250372r16","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1136\/annrheumdis-2018-213023","article-title":"Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study.","volume":"77","author":"Tsao","year":"2018","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"zoi250372r17","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1002\/pds.4930","article-title":"Anti-TNF treatment during pregnancy and birth outcomes: a population-based study from Denmark, Finland, and Sweden.","volume":"29","author":"Br\u00f6ms","year":"2020","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"9","key":"zoi250372r18","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1111\/apt.17224","article-title":"Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study.","volume":"56","author":"Avni-Biron","year":"2022","journal-title":"Aliment Pharmacol Ther"},{"issue":"2","key":"zoi250372r19","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.semarthrit.2016.05.004","article-title":"Tocilizumab use in pregnancy: analysis of a global safety database including data from clinical trials and post-marketing data.","volume":"46","author":"Hoeltzenbein","year":"2016","journal-title":"Semin Arthritis Rheum"},{"issue":"12","key":"zoi250372r20","doi-asserted-by":"publisher","first-page":"5378","DOI":"10.1111\/bcp.15471","article-title":"Reported congenital malformations after exposure to non-tumour necrosis factor inhibitor biologics: a retrospective comparative study in EudraVigilance.","volume":"88","author":"Ghalandari","year":"2022","journal-title":"Br J Clin Pharmacol"},{"issue":"12","key":"zoi250372r21","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1093\/ecco-jcc\/jjac086","article-title":"Safety of ustekinumab and vedolizumab during pregnancy\u2013pregnancy, neonatal and infant outcome: a prospective multicentre study.","volume":"16","author":"Mitrova","year":"2022","journal-title":"J Crohns Colitis"},{"issue":"4","key":"zoi250372r22","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1093\/ibd\/izz037","article-title":"Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD Parenthood Project Working Group.","volume":"25","author":"Mahadevan","year":"2019","journal-title":"Inflamm Bowel Dis"},{"issue":"4","key":"zoi250372r23","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1002\/art.41191","article-title":"2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases.","volume":"72","author":"Sammaritano","year":"2020","journal-title":"Arthritis Rheumatol"},{"issue":"5","key":"zoi250372r24","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1136\/annrheumdis-2015-208840","article-title":"The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation.","volume":"75","author":"G\u00f6testam Skorpen","year":"2016","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"zoi250372r25","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.jaad.2018.11.057","article-title":"Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.","volume":"80","author":"Menter","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"zoi250372r26","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12948-016-0048-x","article-title":"How pregnancy can affect autoimmune diseases progression?","volume":"14","author":"Piccinni","year":"2016","journal-title":"Clin Mol Allergy"},{"issue":"4","key":"zoi250372r27","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"zoi250372r28","doi-asserted-by":"publisher","first-page":"263.e1","DOI":"10.1016\/j.ajog.2022.01.004","article-title":"Prenatal exposure to teratogenic medications in the era of risk evaluation and mitigation strategies.","volume":"227","author":"Sarayani","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"zoi250372r29","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.2147\/CLEP.S269400","article-title":"Impact of the transition from ICD-9-CM to ICD-10-CM on the identification of pregnancy episodes in US health insurance claims data.","volume":"12","author":"Sarayani","year":"2020","journal-title":"Clin Epidemiol"},{"issue":"11","key":"zoi250372r30","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s40264-021-01113-8","article-title":"Validating claims-based algorithms determining pregnancy outcomes and gestational age using a linked claims-electronic medical record database.","volume":"44","author":"Moll","year":"2021","journal-title":"Drug Saf"},{"issue":"1","key":"zoi250372r31","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/EDE.0000000000001559","article-title":"Development and validation of algorithms to estimate live birth gestational age in Medicaid Analytic eXtract Data.","volume":"34","author":"Zhu","year":"2023","journal-title":"Epidemiology"},{"issue":"7","key":"zoi250372r32","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1093\/rheumatology\/kez478","article-title":"Perinatal use and discontinuation of disease-modifying anti-rheumatic drugs and biologics in women with rheumatoid arthritis: a cohort study.","volume":"59","author":"Rebic","year":"2020","journal-title":"Rheumatology (Oxford)"},{"issue":"3","key":"zoi250372r33","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1002\/pds.4695","article-title":"Use of tumor necrosis factor-alpha inhibitors during pregnancy among women who delivered live born infants.","volume":"28","author":"Eworuke","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"zoi250372r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.105738","article-title":"Patterns of disease-modifying therapy utilization before, during, and after pregnancy and postpartum relapses in women with multiple sclerosis.","volume":"88","author":"Bove","year":"2024","journal-title":"Mult Scler Relat Disord"},{"issue":"5","key":"zoi250372r35","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1002\/art.39521","article-title":"Brief report: patterns and secular trends in use of immunomodulatory agents during pregnancy in women with rheumatic conditions.","volume":"68","author":"Desai","year":"2016","journal-title":"Arthritis Rheumatol"},{"issue":"12","key":"zoi250372r36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-065189","article-title":"Comanagement with rheumatology and prescription biologics filled during pregnancy in women with rheumatic diseases: a retrospective analysis of US administrative claims data.","volume":"12","author":"Shridharmurthy","year":"2022","journal-title":"BMJ Open"},{"issue":"4","key":"zoi250372r37","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/S0889-857X(05)70170-8","article-title":"Hormonal alterations in rheumatoid arthritis, including the effects of pregnancy.","volume":"26","author":"Kanik","year":"2000","journal-title":"Rheum Dis Clin North Am"},{"issue":"2-3","key":"zoi250372r38","doi-asserted-by":"publisher","first-page":"J109","DOI":"10.1016\/j.jaut.2011.10.003","article-title":"Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity.","volume":"38","author":"Quintero","year":"2012","journal-title":"J Autoimmun"},{"issue":"Pt 6","key":"zoi250372r39","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1093\/brain\/awh152","article-title":"Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse.","volume":"127","author":"Vukusic","year":"2004","journal-title":"Brain"},{"issue":"7","key":"zoi250372r40","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1111\/j.1471-0528.2011.02931.x","article-title":"What can we really tell women with multiple sclerosis regarding pregnancy? a systematic review and meta-analysis of the literature.","volume":"118","author":"Finkelsztejn","year":"2011","journal-title":"BJOG"},{"issue":"5","key":"zoi250372r41","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/apt.12412","article-title":"The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women.","volume":"38","author":"Pedersen","year":"2013","journal-title":"Aliment Pharmacol Ther"},{"issue":"5","key":"zoi250372r42","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1111\/apt.15596","article-title":"Pregnant women with IBD are more likely to be adherent to biologic therapies than other medications.","volume":"51","author":"Lee","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"issue":"8","key":"zoi250372r43","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1002\/acr.23747","article-title":"Psoriatic arthritis disease activity during and after pregnancy: a prospective multicenter study.","volume":"71","author":"Ursin","year":"2019","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"2","key":"zoi250372r44","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/bdr2.2091","article-title":"Belimumab use during pregnancy: interim results of the belimumab pregnancy registry.","volume":"115","author":"Juliao","year":"2023","journal-title":"Birth Defects Res"},{"issue":"2","key":"zoi250372r45","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1177\/09612033221143286","article-title":"Dilemma of belimumab therapy (dis)continuation during pregnancy: results of a retrospective study in eudravigilance.","volume":"32","author":"Ghalandari","year":"2023","journal-title":"Lupus"},{"issue":"6","key":"zoi250372r46","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1136\/annrheumdis-2017-212535","article-title":"Effect of pregnancy on disease flares in patients with systemic lupus erythematosus.","volume":"77","author":"Eudy","year":"2018","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"zoi250372r47","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1053\/j.gastro.2018.05.040","article-title":"Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development.","volume":"155","author":"Matro","year":"2018","journal-title":"Gastroenterology"},{"issue":"5","key":"zoi250372r48","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/j.gastha.2022.04.009","article-title":"Outcomes of continuation vs discontinuation of adalimumab therapy during third trimester of pregnancy in inflammatory bowel disease.","volume":"1","author":"Truta","year":"2022","journal-title":"Gastro Hep Adv"},{"issue":"7","key":"zoi250372r49","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1093\/ibd\/izz250","article-title":"Early discontinuation of infliximab in pregnant women with inflammatory bowel disease.","volume":"26","author":"Truta","year":"2020","journal-title":"Inflamm Bowel Dis"},{"issue":"9","key":"zoi250372r50","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1093\/rheumatology\/kev404","article-title":"BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids.","volume":"55","author":"Flint","year":"2016","journal-title":"Rheumatology (Oxford)"},{"issue":"7","key":"zoi250372r51","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1002\/acr.24596","article-title":"2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis.","volume":"73","author":"Fraenkel","year":"2021","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"9","key":"zoi250372r52","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/S2352-4642(23)00136-0","article-title":"Immunological effects and safety of live rotavirus vaccination after antenatal exposure to immunomodulatory biologic agents: a prospective cohort study from the Canadian Immunization Research Network.","volume":"7","author":"Fitzpatrick","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"issue":"2","key":"zoi250372r53","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023714","article-title":"Use of biologics during pregnancy and risk of serious infections in the mother and baby: a Canadian population-based cohort study.","volume":"9","author":"Tsao","year":"2019","journal-title":"BMJ Open"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2834117\/ewig_2025_oi_250372_1746730726.75169.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T11:01:15Z","timestamp":1747306875000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2834117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":53,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.10504","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}