title: Is breastfeeding safe with azathioprine?
abstract: BACKGROUND
  Azathioprine is commonly used as an immunosuppressant during pregnancy in the management of various conditions such as connective tissue disorders, inflammatory bowel disease and pregnant women with organ transplant. Continuation of azathioprine through pregnancy and postpartum is vital for maternal reasons. However, there is limited evidence regarding safety of use of azathioprine with breastfeeding.
  
  
  RESULTS
  We report an observational case series of 10 mother-baby pairs managed at a tertiary teaching hospital. Mothers on azathioprine who were keen to breastfeed were counselled antenatally regarding limited short-term and long-term safety data for the babies. Mothers participating in this study completed a questionnaire at every visit. At follow-up visits, babies were examined by a neonatologist for clinical signs of infection and checked for adverse effects on haematological profile.
  
  
  CONCLUSIONS
  There was no clinically significant adverse effect on haematological profile or immunosuppression in these babies. Our case series supports safety of azathioprine in the short term. However, large numbers are needed to determine long-term safety of azathioprine and breastfeeding.
authors: Women's and Perinatal Services, Leicester Royal Infirmary, University Hospital Leicester, Leicester , UK.
authors: Mandeep
authors: M
authors: Singh
authors: Women's and Perinatal Services, Leicester Royal Infirmary, University Hospital Leicester, Leicester , UK.
authors: Jan
authors: J
authors: Qualie
authors: Women's and Perinatal Services, Leicester Royal Infirmary, University Hospital Leicester, Leicester , UK.
authors: Andrew
authors: A
authors: Currie
authors: Women's and Perinatal Services, Leicester Royal Infirmary, University Hospital Leicester, Leicester , UK.
authors: Edmund S
authors: ES
authors: Howarth
authors: Women's and Perinatal Services, Leicester Royal Infirmary, University Hospital Leicester, Leicester , UK.
authors: Manjiri M
authors: MM
authors: Khare
keywords: azathioprine; breastfeeding; maternal–fetal medicine