Our expert says:
It appears that there are some risks associated with azapress use in preganncy, but these are not clearcut. I enclose further information.
' Many studies found an increased risk of fetal growth retardation, lymphopenia, decreased thymus size and prematurity (Bermas and Hill, 1995, Connell and Miller, 1999 and Witter et al., 1981). The malformation rate was 3.9%, which is close to the general population rate. The association between azathioprine and IUGR appears to be the highest when used in combination with a corticosteroid such as prednisone. Thus the direct role of azathioprine in infants with IUGR is difficult to determine as other medications (corticosteroids have been associated with IUGR).
A potential risk for chromosome anomalies has been raised following a case report of a woman with lupus who took the drug during two different pregnancies. She delivered two infants with separate de novo translocations. Due to these being isolated cases it is unlikely a true association. However, further investigation is required to determine if this is a true risk from gestational exposure to azathioprine (Bermas and Hill, 1995, Connell and Miller 1999, Reprotox #1459, 1980 and Witter et al., 1981).
There is one study of azathioprine use in pregnant patients with inflammatory bowel disease. This study did not find an increased risk for congenital abnormalities or subsequent health problems (Connell and Miller, 1999 and Connell and Sandborn 1999). Still, due to the potential risks, azathioprine and mercaptopurine are usually not prescribed in pregnancy unless the disease is severe (Connell and Sandborn 1999).
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