IBD and Pregnancy

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IBD and Pregnancy
Bindia Jharap Medical doctor/ PhD student VU
university medical center Amsterdam
Dineke Kanis IBD nurse specialist VU university
medical center Amsterdam
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• In general - Dineke
• Thiopurines and pregnancy - Bindia
• Patient Views - Dineke

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Thiopurines

• Azathioprine (AZA) Imuran
• 6-Mercaptopurine (6-MP) Purinethol
• 6-Thioguanine (6-TG) Lanvis)

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Metabolism of thiopurines

• 6-TGN ? myelotoxicity
• 6-MMP ? hepatotoxicity

De Boer et al. 2006
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Pregnancy and IBD
Cornish et al. GUT 2007
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Thiopurines relatively safe during pregnancy
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Conflicting data
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In practice

• Active Crohns disease and ulcerative colitis
  during pregnancy are associated with preterm
  births and congenital malformations
• Experience thiopurines are relatively safe
  during pregnancy

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What is known about the intrauterine exposure of
infants to thiopurines?

• Thiopurines cross the placenta
• 6-TGN can be measured in fetal blood
• Deficiency of liver enzymes in fetus

Saarokoski et al. 1973Janssen et al.
2000de Boer et al. 2005 en 2006
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Thiopurine metabolite measurements during
pregnancy in mother and child
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• Aim of the study
• 1. Influence of pregnancy on
• 6-TGN en 6-MMP concentrations
• 2. Intrauterine exposure of fetus to
• thiopurines

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Methods

• Multicenter study
• IBD patients and wish to become pregnant
• Use of thiopurines

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Time schedule
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Analysis 10 pregnancies
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6-TGN (mother)
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6-MMP (mother)
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6-TGN and 6-MMP in mother and child

• P 0.018

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Characteristics of infants
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Thiopurine metabolites in breast milk
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Conclusion

• Thiopurine metabolites may vary highly during
• pregnancy in IBD patients
• 6-TGN was detected in all infants, but 6-MMP
  not
• No toxicity in all infants
• Breastfeeding seems not contra-indicated