Anti-TNF-α Treatment Improves the Live Birth Rate and Reduces the Risk of Premature Delivery in Patients with Recurrent Spontaneous Abortion.

Immunity and inflammation contribute to the development of recurrent spontaneous abortion (RSA); tumor necrosis factor inhibitor (TNFi) is a well-known anti-inflammation treatment for immune diseases. This study aimed to investigate the effect of TNFi on pregnancy outcomes and tolerance in RSA patients. This retrospective, observational study analyzed 115 RSA patients. Forty-three patients received TNFi plus intravenous immunoglobin (IVIG) and low molecular weight heparin (LMWH) treatment (the TNFi group), whereas another 72 patients received IVIG plus LMWH or LMWH alone treatment (the Control group). TNFi agents included certolizumab, etanercept, and adalimumab. The live birth rate was greater in the TNFi group than in the Control group (72.1% vs. 45.8%, P = 0.006), whereas the premature delivery rate tended to be lower in the TNFi group vs. the Control group but did not reach statistical significance (9.7% vs. 24.2%, P = 0.123). Multivariable logistic regression revealed that treatment (TNFi vs. Control) was independently correlated with greater live birth achievement (P = 0.001, odds ratio = 5.470); furthermore, treatment (TNFi vs. Control) tended to be independently associated with a reduced premature delivery risk (P = 0.055, odds ratio = 0.178). The type of labor (P = 0.321), neonatal birth weight (P = 0.159), and newborn Apgar score (P = 0.233) did not differ between the TNFi group and the Control group. Furthermore, adverse events, including rash, gestational hypertension, abnormal liver function index, ecchymosis, fever, and abnormal renal function index were not different between the TNFi and Control groups (all P > 0.05). TNFi improves live birth rate and tends to reduce premature delivery risk in RSA patients, providing a potential treatment option.