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 17 January 2018

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News

Pregnancy and child development after cessation of 6-mercaptopurine

Fetal loss is higher in women with inflammatory bowel disease, who had been previously treated with 6-mercaptopurine, compared with those who had not, finds a research team in the April issue of the Journal of Clinical Gastroenterology.

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6-mercaptopurine (6-MP) has proven efficacy in the treatment of inflammatory bowel disease (IBD).

The teratogenicity of 6-MP has been demonstrated in animal studies at very high doses, however, human data suggest that 6-MP at maintenance doses is safe.

In this study, researchers from New York, USA, assessed the outcome of 72 pregnancies in patients with IBD. Patients had been previously treated with 6-MP at 3 different doses (50, 75, and 100 mg per day), for a median of 18 months. The research team also followed-up their children.

The team compared the outcome of pregnancies and development of offspring in 2 groups of patients. They assessed those patients with IBD who conceived 6 months to 22 years after stopping 6-MP (group 1) and patients with IBD who never received 6-MP prior to conception (group 2).

The researchers evaluated all pregnancies in terms of outcome. Outcomes included live full-term birth, premature delivery, stillbirth, spontaneous abortion, ectopic pregnancy, and therapeutic dilatation and curettage.

Incidence of fetal loss:
- 6-mercaptopurine = 29%
- control = 14%
Journal of Clinical Gastroenterology

The team also obtained data, regarding birth weight, congenital anomalies, and development, on all children.

Group 1 included 72 pregnancies carried by 29 women. The researchers found that in this group there were 51 live births (4 premature), 16 spontaneous abortions, 1 stillbirth, 2 therapeutic abortions due to abnormal amniocentesis, and 2 ectopic pregnancies.

The total incidence of fetal loss was 29%.

However, in group 2, 75 women had 140 pregnancies resulting in 120 live births (8 premature), 18 spontaneous abortions, and 2 stillbirths.

The team found that there were no cases of ectopic pregnancies or abnormal amniocentesis in group 2.

The total incidence of fetal loss was 14%.

They also found no increase in the incidence of developmental defects where mothers had been treated with 6-MP prior to pregnancy.

Dr Jusuf Zlatanic’s team concluded, “The incidence of fetal loss is higher in women with inflammatory bowel disease who had been previously treated with 6-MP compared with those who had not”.

“Whether this was related to the older age at conception in 6-MP group, longer duration of disease, initially more severe disease, or use of 6-MP we cannot tell.”

J Clin Gastroenterol 2003; 36(4): 303-9
19 March 2003

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