Pregnancy outcome of women exposed to azathioprine during pregnancy

Goldstein, Lee H.; Dolinsky, Galit; Greenberg, Revital; Schaefer, Christof; Cohen‐Kerem, Raanan; Diav–Citrin, Orna; Malm, Heli; Reuvers-Lodewijks, Minke. E.; Driel, Margreet M. Rost van Tonningen-van; Arnon, Judy; Ornoy, Asher; Clementi, Maurizio; Gianantonio, Elena Di; Koren, Gideon; Braunstein, Rony; Berkovitch, Matitiahu

doi:10.1002/bdra.20399

Cited by 171 publications

(104 citation statements)

References 29 publications

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“…Azathioprine is listed by the U.S. Food and Drug Administration as a category D drug, but it has been used in thousands of pregnant women. One recent study that compared 189 women exposed to azathioprine and 230 women not exposed found no difference in the frequency of congenital anomalies (28).…”

Section: Immunosuppressive Drugs In Pregnancymentioning

confidence: 96%

A Woman with GN Presenting during Pregnancy

Hou

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe combination of kidney disease and pregnancy has long been recognized as a high-risk situation. When renal disease is recognized for the first time during pregnancy, it presents unique problems for both the obstetric and the renal teams. Particularly difficult can be distinguishing preeclampsia from preexisting kidney disease in women presenting for the first time with hypertension, proteinuria, and reduced GFR during pregnancy. Decision-making regarding performing a kidney biopsy and treatment of glomerular disease during pregnancy is often much more complicated by safety concerns for both the mother and the developing fetus.

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Section: Immunosuppressive Drugs In Pregnancymentioning

confidence: 96%

A Woman with GN Presenting during Pregnancy

Hou

2013

Clinical Journal of the American Society of Nephrology

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“…A multicenter study found no difference in the fetal malformation rate between pregnancies exposed to azathioprine and unexposed pregnancies, but there was an association of azathioprine with lower birth weight, gestational age and prematurity [7]. Leukopenia and/or thrombocytopenia may occur in a proportion of neonates whose mothers took azathioprine throughout their pregnancies.…”

Section: Immunosuppression In Pregnant Women With Systemic Lupus Erytmentioning

confidence: 99%

Immunosuppression in pregnant women with systemic lupus erythematosus

Ponticelli

Moroni

2015

Expert Review of Clinical Immunology

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“…AZA and 6-MP, both purine analogs, are pregnancy category "D" drugs, since gestational animal studies show a defined association with birth defects. Because of their cytotoxicity, and potential risk of birth defects, they should be used with great care during pregnancy [111] . Immunomodulators alter the activity of the immune system in order to decrease the body's inflammatory response and cause an overall immunosuppressive effect.…”

Section: -Mp/azamentioning

confidence: 99%

“…However, if there is a medical history of unexplained infertility or miscarriages, men should discontinue taking thiopurines at least four months before conception to improve fertility [114] . Conversely, Goldstein et al [111] studied 189 women who took AZA for different indications and later contacted a birth defects registry following delivery. That study failed to find a statistically significant increase in the rate of malformations (compared to 230 women who contacted the same service that were not on any potentially teratogenic treatment).…”

Section: -Mp/azamentioning

confidence: 99%

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Hosseini‐Carroll¹,

Mutyala²,

Seth³

et al. 2015

WJGPT

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Manas K made critical revisions of the manuscript; Becker F and Alexander JS contributed equally as senior authors. Conflict-of-interest statement:There are no known conflicts of interest. The authors (Pegah Hosseini-Carroll, Monica Mutyala, Abhishek Seth, Shaheen Nageeb, Demiana Soliman, Moheb Boktor, Ankur Sheth, Jonathon Chapman, James Morris, Paul Jordan, Kenneth Manas, Felix Becker, and J Steven Alexander) have no relevant financial considerations related to this proposal, and the study was not supported by any corporate entity. There is no known intellectual property associated with this report. AbstractInflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during 157November 6, 2015|Volume 6|Issue 4| WJGPT|www.wjgnet.com Hosseini-Carroll P et al . Pregnancy and inflammatory bowel diseases IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using "top-down" care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. Core tip: Inflammatory bowel diseases (IBD) are chronic inflammatory conditions characterized by relapsing and remitting episodes of intestinal inflammation. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While therapies have improved dramatically, IBDs have important effects on pregnancy and present challenges for maintaining optimal outcomes for mothers and their developing fetus/ neonate. Women with IBD and physician...

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Pregnancy outcome of women exposed to azathioprine during pregnancy

Abstract: These results suggest that AZP (50-100 mg/day) does not triple the rate of birth defects; however, it is associated with lower birth weight, gestational age, and prematurity. Larger studies are needed to confirm these observations.

Cited by 171 publications

References 29 publications

A Woman with GN Presenting during Pregnancy

A Woman with GN Presenting during Pregnancy

Immunosuppression in pregnant women with systemic lupus erythematosus

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

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