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Early Pregnancy Azathioprine Use and Pregnancy Outcomes

Cleary, Brian J. and Källén, Bengt LU (2009) In Birth Defects Research. Part A: Clinical and Molecular Teratology2003-01-01+01:002013-01-01+01:00 85(7). p.647-654
Abstract
BACKGROUND: Azathioprine (AZA) is used during pregnancy by h omen with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was Studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and... (More)
BACKGROUND: Azathioprine (AZA) is used during pregnancy by h omen with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was Studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45-6.04)Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93-2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness. Birth Defect: Research (Part A) 85:647-654, 2009. (C) 2009 Wiley-Liss, Inc. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
preterm birth, pregnancy, congenital malformations, atrial septal defect, azathioprine, ventricular septal defect
in
Birth Defects Research. Part A: Clinical and Molecular Teratology2003-01-01+01:002013-01-01+01:00
volume
85
issue
7
pages
647 - 654
publisher
John Wiley & Sons
external identifiers
  • wos:000268426000008
  • scopus:67651166726
ISSN
1542-0760
DOI
10.1002/bdra.20583
language
English
LU publication?
yes
id
2281a64b-fbb9-4ae7-b2c2-9398fc1cc48d (old id 1460680)
date added to LUP
2009-08-31 10:42:09
date last changed
2017-12-10 03:55:28
@article{2281a64b-fbb9-4ae7-b2c2-9398fc1cc48d,
  abstract     = {BACKGROUND: Azathioprine (AZA) is used during pregnancy by h omen with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was Studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45-6.04)Exposed infants were also more likely to be preterm, to weigh &lt;2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93-2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness. Birth Defect: Research (Part A) 85:647-654, 2009. (C) 2009 Wiley-Liss, Inc.},
  author       = {Cleary, Brian J. and Källén, Bengt},
  issn         = {1542-0760},
  keyword      = {preterm birth,pregnancy,congenital malformations,atrial septal defect,azathioprine,ventricular septal defect},
  language     = {eng},
  number       = {7},
  pages        = {647--654},
  publisher    = {John Wiley & Sons},
  series       = {Birth Defects Research. Part A: Clinical and Molecular Teratology2003-01-01+01:002013-01-01+01:00},
  title        = {Early Pregnancy Azathioprine Use and Pregnancy Outcomes},
  url          = {http://dx.doi.org/10.1002/bdra.20583},
  volume       = {85},
  year         = {2009},
}