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    Early pregnancy azathioprine use and pregnancy outcomes.

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    Authors
    Cleary, Brian J
    Kallen, Bengt
    Affiliation
    Pharmacy Department, Coombe Women and Infants University Hospital, Dublin 8,, Ireland. bcleary@coombe.ie
    Issue Date
    2012-02-01T10:57:54Z
    MeSH
    Abnormalities, Drug-Induced/epidemiology/metabolism
    Adult
    Anti-Inflammatory Agents/*adverse effects
    Azathioprine/*adverse effects
    Congenital Abnormalities/epidemiology
    Female
    Humans
    Infant, Newborn
    Inflammatory Bowel Diseases/drug therapy
    Middle Aged
    Pregnancy
    Pregnancy Outcome/*epidemiology
    Registries
    Young Adult
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    Metadata
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    Citation
    Birth Defects Res A Clin Mol Teratol. 2009 Jul;85(7):647-54.
    Journal
    Birth defects research. Part A, Clinical and molecular teratology
    URI
    http://hdl.handle.net/10147/208020
    DOI
    10.1002/bdra.20583
    PubMed ID
    19343728
    Abstract
    BACKGROUND: Azathioprine (AZA) is used during pregnancy by women 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.
    Language
    eng
    ISSN
    1542-0760 (Electronic)
    1542-0752 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1002/bdra.20583
    Scopus Count
    Collections
    Coombe Women & Infants University Hospital

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