Exposure to hydroxyurea and pregnancy outcomes in patients with sickle cell anemia.
The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) was a randomized double-blind placebo-controlled trial to test whether hydroxyurea could reduce the rate of painful crises in adults who had at least 3 painful crises per year. Because hydroxyurea is known to be carcinogenic, mutagenic, and teratogenic in animals, a major inclusion criterion in MSH was the use of contraceptives both by females and males in order to avoid exposure of the fetus to hydroxyurea. Despite this precautionary measure, some women became pregnant while taking hydroxyurea or their male partners were on hydroxyurea. We followed surviving patients who were enrolled in the original MSH trial for up to 17 years postrandomization. Our findings suggest that exposure of the fetus to hydroxyurea does not cause teratogenic changes in those pregnancies that terminate in live birth whether full-term or premature. This seems to be true whether the parent taking hydroxyurea was the mother or the father. The same argument seems to apply for exposure to opioids. However, it will take a much longer follow-up of many more hydroxyurea-exposed sickle cell disease subjects to establish the results conclusively.
Sickle Cell Center, Cardeza Foundation for Hematologic Research, Jefferson Medical College, 1015 Walnut St, Philadelphia, PA 19107, USA. samir.ballas@jefferson.edu
Samir K
SK
Ballas
William F
WF
McCarthy
Nan
N
Guo
Laura
L
DeCastro
Rita
R
Bellevue
Bruce A
BA
Barton
Myron A
MA
Waclawiw
D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D000986:Antisickling Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D006918:Hydroxyurea / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects
D000986:Antisickling Agents; D006918:Hydroxyurea