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Medications and More during pregnancy and breastfeeding

Azathioprine/6-mercaptopurine

Selected References:

  • Akbari M, et al. 2013. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis, 19(1):15-22.
  • Alami Z, et al. 2018. Pregnancy outcome following in utero exposure to azathioprine: a French comparative observational study. Therapie, 73(3):199-207.
  • Alshwairikh LA, Zeneb B. 2022. A 25-year-old Saudi woman with a 2-year history of antisynthetase syndrome with interstitial lung disease who commenced azathioprine treatment in the third trimester of pregnancy and had a successful birth at term. Am J Case Rep, 7:23:e936833.
  • Balevic S, et al. 2024. Azathioprine metabolite levels and outcomes during pregnancies with rheumatic disease. Lupus Sci Med, 11(1):e0011036.
  • Casanova MJ, et al. 2013. Safety of thiopurines and anti-TNF-alpha drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol, 108(3):433-440.
  • Christensen LA, et al. 2008. Azathioprine treatment during lactation. Aliment Pharmacol Ther, 28(10):1209-1213.
  • Davison JM et al. 1985. Maternal azathioprine therapy and depressed haematopoiesis in the babies of renal allograft patients. Br J Obstet Gynaecol, 92:233-239.
  • de Meij TG, et al. 2013. Dutch Initiative on crohn and colitis. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther, 38(1):38-43.
  • Dejaco C, et al. 2001. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology, 121:1048-53.
  • Francella A, et al. 2003. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology, 124(1):9-17.
  • Friedman S, et al. 2017. Paternal use of azathioprine/6-mercaptopurine or methotrexate within 3 months before conception and long-term health outcomes in the offspring: a nationwide cohort study. Reproductive Toxicology, 73:196-200.
  • Götestam Skorpen C, et al. 2016. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis, 75(5):795-810.
  • Goldstein LH, et al. 2007. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects Res A Clin Mol Teratol, 79(10):696-701.
  • Hoeltzenbein M, et al. 2012. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. Reprod Toxicol, 34(3):364-369.
  • Ikram N, at al. 2021. Breastfeeding in women with rheumatic diseases. Lupus Sci Med, 8(1):e000491.
  • Khedr L, Ekram M. 2024. Eur J Case Rep Intern Med, 11(4):004385.
  • Kinnucan J, Kane S. 2021. Editorial: thiopurines but not anti-TNF monotherapy are linked to worse pregnancy outcomes in a large population-based study. Aliment Pharmacol Ther, 54(3):343-344.
  • Langagergaard V, et al. 2007. Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: a Danish nationwide cohort study. Aliment Pharmacol Ther, 25(1):73-81.
  • Matalon ST, et al. 2004. Review of the potential effects of three commonly used antineoplastic and immunosuppressive drugs (cyclophosphamide, azathioprine, doxorubicin on the embryo and placenta). Reprod Toxicol, 18(2):219-230.
  • Matarazzo L, et al. 2021. Pregnancy outcome in women with childhood onset autoimmune hepatitis and autoimmune sclerosing cholangitis on long-term immunosuppressive treatment. Eur J Obstet Gynecol Reprod Biol, 268:7-11.
  • Moretti ME et al. 2006. Breast-feeding during maternal use of azathioprine. Ann Pharmacother, 40(12):2269-2272.
  • Motta M, et al. 2007. Immune system development in infants born to mothers with autoimmune disease, exposed in utero to immunosuppressive agents. Am J Perinatol, 24(8):441-447.
  • Myer A, et al. 2021. Comparative study of pregnancy outcomes in women with inflammatory bowel disease treated with thiopurines and/or anti-TNF: a French nationwide study 2010-2018. Aliment Pharmacol Ther, 54(3):302-311.
  • Nørgård B, et al. 2004. The risk of congenital abnormalities in children fathered by men treated with azathioprine or mercaptopurine before conception. Aliment Pharmacol Ther, 19(6):679-685.
  • Reynolds JA, et al. 2023. Outcomes of children born to mothers with systemic lupus erythematosus exposed to hydroxychloroquine or azathioprine. Rheumatology (Oxford), 62(3):1124-1135.
  • Skejo C, et al. 2024. Early onset sepsis and lobar pneumonia in a newborn exposed in utero to Ustekinumab and azathioprine. Inflamm Bowel Dis, 30(2):314-315.
  • Wolf MF, et al. 2023. Azathioprine and 6-mercaptopurine-induced intrahepatic cholestasis of pregnancy: case report and review of literature: Taiwan J Obstet Gynecol, 63(5):761-764.

MotherToBaby cuenta con el apoyo de la Administración de Recursos y Servicios de Salud (HRSA) del Departamento de Salud y Servicios Humanos de los Estados Unidos (HHS) como parte de una adjudicación por un total de $6,000,000 con cero porcentaje financiado con fuentes no gubernamentales. Los contenidos son los del autor/es y no representan necesariamente los puntos de vista oficiales de, ni un respaldo, por HRSA, HHS o el Gobierno de los Estados Unidos.