{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:58:55Z","timestamp":1780894735993,"version":"3.54.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Infants born to mothers with autoimmune rheumatic diseases, including rheumatoid arthritis, spondyloarthropathy, and inflammatory bowel disease, may be exposed antenatally to tumor necrosis factor-alpha (TNF-\u03b1) inhibitors. Recent guidelines recommend deferring live attenuated vaccines, such as Bacillus Calmette\u2013Gu\u00e9rin (BCG), until after 6\u201312\u202fmonths of age in this population, owing to conflicting safety data. This study aimed to evaluate the safety of administering BCG vaccination at birth in infants exposed to TNF-\u03b1 inhibitors in utero.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We retrospectively screened the electronic health records of women with autoimmune rheumatic diseases treated with TNF-\u03b1 inhibitors during pregnancy. Only children with complete health records from infancy were included in the analysis. Data were obtained from the largest health system in Qatar. Information on obstetric history, type and duration of TNF-\u03b1 inhibitor therapy during pregnancy, age at BCG vaccine administration, adverse reactions to the vaccine, and any infections and hospitalizations documented during infancy was collected. Descriptive statistics and univariate analyses were used to assess factors associated with infection and hospitalization using SPSS (version 27.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 63 infants exposed to TNF-\u03b1 inhibitors in utero, 49 (77.8%) of whom received BCG vaccination within the first year of life, including 27 infants (42.8%) who were vaccinated at birth. Most infants vaccinated at birth (20\/27) were exposed to TNF-\u03b1 inhibitors during the third trimester. Certolizumab was the most frequently prescribed agent. Over half of the children in this cohort experienced at least three infections during infancy; however, none developed disseminated tuberculosis. Exposure to TNF-\u03b1 inhibitors did not demonstrate an increased risk of infection or hospitalization during the first year of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BCG vaccination at birth did not result in disseminated tuberculosis, even among infants exposed to TNF-\u03b1 inhibitors during the third trimester.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1812473","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:37Z","timestamp":1780892617000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of disseminated tuberculosis and other infections after neonatal Bacillus Calmette\u2013Gu\u00e9rin vaccination in infants with in-utero exposure to tumor necrosis factor-\u03b1 inhibitors"],"prefix":"10.3389","volume":"13","author":[{"given":"Samar","family":"Al Emadi","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seham","family":"Alebbi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawal","family":"Hadwan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Alsaed","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka Moovara","family":"Cackamvalli","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevin","family":"Abunahia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Satti","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hamad Medical Corporation","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.rdc.2016.12.003","article-title":"Preconception counseling","volume":"43","author":"\u00d8stensen","year":"2017","journal-title":"Rheum Dis Clin N 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