Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME Study.
OBJECTIVE
Few studies have been conducted addressing the safety of thiopurine treatment in pregnant women with inflammatory bowel disease (IBD). The aim of this study was to evaluate the pregnancy outcome of women with IBD who have been exposed to thiopurines.


METHODS
215 pregnancies in 204 women were registered and documented in the CESAME cohort between May 2004 and October 2007. Physicians documented the following information from the women: last menstrual date, delivery term, details of pregnancy outcome, prematurity, birth weight and height, congenital abnormalities, medication history during each trimester, smoking history and alcohol ingestion. Data were compared between three groups: women exposed to thiopurines (group A), women receiving a drug other than thiopurines (group B) and women not receiving any medication (group C).


RESULTS
Mean age at pregnancy was 28.3 years. 75.7% of the women had Crohn's disease and 21.8% had ulcerative colitis, with a mean disease duration of 6.8 years at inclusion. Of the 215 pregnancies, there were 138 births (142 newborns), and the mean birth weight was 3135 g. There were 86 pregnancies in group A, 84 in group B and 45 in group C. Interrupted pregnancies occurred in 36% of patients enrolled in group A, 33% of patients enrolled in group B, and 40% of patients enrolled in group C; congenital abnormalities arose in 3.6% of group A cases and 7.1% of group B cases. No significant differences were found between the three groups in overall pregnancy outcome.


CONCLUSIONS
The results obtained from this cohort indicate that thiopurine use during pregnancy is not associated with increased risks, including congenital abnormalities.
Department of Digestive Diseases, Lariboisière Hospital, Paris, France.
Jessica
J
Coelho
Laurent
L
Beaugerie
Jean Frédéric
JF
Colombel
Xavier
X
Hébuterne
Eric
E
Lerebours
Marc
M
Lémann
Philippe
P
Baumer
Jacques
J
Cosnes
Arnaud
A
Bourreille
Jean Pierre
JP
Gendre
Philippe
P
Seksik
Antoine
A
Blain
Etienne H
EH
Metman
Andrée
A
Nisard
Guillaume
G
Cadiot
Michel
M
Veyrac
Benoît
B
Coffin
Xavier
X
Dray
Fabrice
F
Carrat
Philippe
P
Marteau
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology; D008431:Maternal-Fetal Exchange; D015122:Mercaptopurine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D015122:Mercaptopurine