<p>Fetal Acrania (Exencephaly) in the Context of a Pregnant Female Taking Adalimumab for Psoriasis: A Case Report</p>

Abstract

Adalimumab is a fully human, recombinant, IgG1 monoclonal antibody that targets tumor necrosis factor-alpha (TNF-alpha). It has been established that adalimumab can cross the placenta and can be detected in the fetal circulation for up to 6 months postpartum. However, clinical studies have failed to show any consistent or specific adverse fetal outcomes from maternal exposure to adalimumab during pregnancy. In our report, we present a case of fetal acrania (exencephaly) in the setting of a pregnant female taking adalimumab prior to and during pregnancy. Exencephaly is a neural tube defect (NTD) that results from failure of closure of the neural fold. It is true that there were other risk factors that might have contributed to our patient’s unfortunate outcome. For example, she did not take folic acid supplementation prior to or during her pregnancy. Nonetheless, studies have shown that folic acid deficiency alone is not sufficient to lead to the development of NTDs. Our patient’s exposure to adalimumab during her pregnancy might have added to the risk in her situation. Our report aims to inform clinicians of that possible risk and to stimulate them to report any similar outcomes.

Successful treatment of dissecting cellulitis with certolizumab pegol in a pregnant patient

“… 1 , 3 , 2 However, adalimumab has been well-established as being able to cross the placenta, and it may be detected in the fetal circulation for up to 6 months postpartum. 4 Thus, it may not be the ideal candidate for a pregnant patient.…”

Fetal acrania diagnosed at 17 weeks of gestation by 2D/3D ultrasound: a case report and literature review

“…Other drugs taken prior or during first weeks of pregnancy have also been reported as risk factors for fetal acrania. In a recent report published by Daham et al, fetal acrania was associated with maternal exposure to Adalimumab, a fully human, recombinant, immunoglobulin G1 (IgG1) monoclonal antibody that targets tumor necrosis factor-alpha (TNF-α), used for the treatment of psoriasis [ 8 ].…”