{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:22:56Z","timestamp":1789035776262,"version":"build-2803163510"},"reference-count":44,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011110","name":"UCB","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011110","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022115","name":"Dutch Arthritis Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022115","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002999","name":"Dutch Ministry of Health, Welfare, and Sport","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002999","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,8,14]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>While protection against pertussis following maternal tetanus-diphtheria-and-acellular-pertussis (Tdap) vaccination was demonstrated in healthy term-born infants, no evidence is available on Tdap vaccination in combination with immune-modulating therapy during pregnancy. In this pilot study, we explored whether treatment with tumour necrosis factor alpha inhibitors (TNFis) in pregnant patients with rheumatic disease interferes with Tdap vaccine responses and affects maternal anti-pertussis IgG antibody levels in newborns.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients were included by a rheumatologist during pregnancy in case they received maternal Tdap vaccination in the late-second or early-third trimester of pregnancy. Blood samples were obtained from mothers during the first pregnancy trimester, 3 months after delivery and from the umbilical cord. IgG antibody levels against Tdap-included antigens were measured using a bead-based multiplex immunoassay. Findings on patients exposed to TNFis were compared with those from TNFi-unexposed patients and with data from a historical comparator study among healthy Tdap vaccinated mother\u2013infant pairs (n=53).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>66 patients (46 exposed and 20 unexposed to TNFIs) were enrolled. No major differences in IgG antibody levels were observed between TNFi-exposed and unexposed mothers before maternal Tdap vaccination and 3 months after delivery. In cord sera, however, antibody levels against pertussis toxin were significantly lower after TNFi-treatment (35.94 IU\/mL, 95% CI 20.68 to 62.45) compared with no TNFi-treatment of mothers with rheumatic disease (94.61 IU\/mL, 95% CI 48.89 to 183.07) and lower compared with a cohort of healthy mothers (125.12 IU\/mL, 95% CI 90.75 to 172.50). We observed similar differences for filamentous haemagglutinin, pertactin, tetanus toxoid and diphtheria toxoid.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These preliminary data indicate no major differences in IgG antibody levels on maternal Tdap vaccination in pregnant women with or without immune-modulating treatment, although our findings suggest that TNFis during pregnancy induce lower maternal anti-pertussis-specific protective antibody levels in newborns.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-002985","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T12:50:17Z","timestamp":1693227017000},"page":"e002985","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Maternal and neonatal antibody levels on pertussis vaccination in pregnant women on immune-modulating therapy for rheumatic disease"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7130-2749","authenticated-orcid":false,"given":"Nafise","family":"Ghalandari","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands"},{"name":"Medicines Evaluation Board, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten M","family":"Immink","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands"},{"name":"Department of Obstetrics, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-3838","authenticated-orcid":false,"given":"Esther","family":"R\u00f6der","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia C J","family":"Bruijning-Verhagen","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7724-7712","authenticated-orcid":false,"given":"Hieronymus","family":"Smeele","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubertina","family":"Crijns","sequence":"additional","affiliation":[{"name":"Medicines Evaluation Board, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoline A T","family":"van der Maas","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireille N","family":"Bekker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth A M","family":"Sanders","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, 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