TNF and autoimmune disease: Most studies have focused on earlier approved biologics, such as tumor necrosis factor (TNF) inhibitors13,14,15,16; pregnancies ending in live births17,18; or infant rather than maternal outcomes.14,16 Studies evaluating newer biologics, such as tocilizumab19,20 and vedolizumab,20,21 in pregnant populations are limited, leading to inconsistent recommendations regarding use of biologics during pregnancy.22,23,24,25 The complexity of the issue is compounded by the heterogeneous effect of pregnancy on the underlying autoimmune disease.