In theory azathioprine is more dangerous at the moment of conception for its teratogenic potential than during pregnancy as it does not reach the fetus in its active form. So theoretically it could be administered to a pregnant woman. However, it is known that pregnancy increases the production of endogenous cortisol and often induces remission of inflammatory bowel diseases. Therefore, the problem is that of the common use of drugs in pregnancy: they are to be used only in cases of extreme necessity. In ulcerative colitis, if in remission it may be suspended (most cases), if in an active phase (rarely) it can be changed to an anti-TNF alpha, that is safe until the sixth month.
I'm afraid I disagree Iearadi Enzo. Azathioprine is to be continued for the vast majority of women with IBD. The risk of a flare of IBD far outweighs any drug related risks. The fairly good safety profile of Azathioprine during pregnancy at doses given for IBD has been shown in number studies. The ECCO guidelines are very clear. I would strongly encourage any IBD physician to continue maintenance medication during pregnancy (except MTX). Anti-TNF are not safer during pregnancy than Azathioprine. This is a myth!
Anyone wanting more information please read the ECCO guidelines!
Though AZA is listed as category D drug for pregnancy but number of studies in gastro as well as other disciplines like rheumatology, nephrology has showed non harmfulness of it in pregnancy including recent ECCO guidelines and DDW presentation by Uma Mahadevan.
I completely agree with dr. Selinger. Disease flare during pregnancy will expose the fetus to a greater risk for being born to small for gestational age and other unwanted outcomes. Although 1/3 improve during pregnancy, 1/3 also relapses during pregnancy. We always continue thiopurines during pregnancy, and we have run through the literature when we published a national guideline (in Danish), which is in line with the current ECCO guideline.
As I am working on mathematical model for azathioprine metabolism I happen to read this interesting discussion. I have a question in relation to azathioprine use in pregnancy.
In theory azathioprine metabolites are active in the immunosuppression. These are formed and act inside the fastly growing cells like bone marrow. Since they can be supplied to fetus through umbilical vein, aren't there any chances of neutropenia in fetus after birth?
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