P361 Effects of azathioprine on outcome of pregnancy in Inflammatory Bowel Disease patients: A prospective study
L. Kecili*, N. Bounab, N. Kaddache, K. Layaida, T. Boucekkine, N. Debzi, S. Berkane
CHU Mustapha, Gastroenterology, Alger, Algeria
It is generally believed that Azathioprine (AZT) is harmless in pregnancy(P)of inflammatory Bowel
Disease patients(IBD) both for the pregnant women and fetus .Nevertheless studies are rare,frequently retrospective and concern generally small cohorts .
To assess in a prospective study influence of AZT on fetal prognosis and natural history of the
disease in IBD pregnant patients ,we have enrolled 261 consecutive IBD patients in a prospective long term follow-up study from 1/1/2005 to 31/12/2009 of whom 244 (Group I;GI) were pregnant during the study or have had pregnancies;37 had no P (Group II;GII). 37 patients (19 Ulcerative colitis :UC and 18 Crohn's disease :CD) received AZT (2,5 mg/kg/day),(GI:n=30;GII:n=7) during 29 to 36 months.Evaluation was based on characteristics of the last P with AZT and its outcome. Statistical analysis : Student Fisher's t test and Mann Withney's U test.
Comparison of IBD GI patients who received AZT (IBD/GI/AZT+) and GI patients who did not received AZT
(IBD/GI/AZT-) did not show any significant statistical difference (SSD) as regards to demographic and anatomoclinical characteristics ,gestational statute and outcome of disease.The same Results were found when comparing UC/GI/AZT+ patients and UC/GI/AZT- patients. In return,CD/GI/AZT+ patients differ from CD/GI/AZT- patients by a greater number of anoperineal(27,7% vs 17,5%;p<0,4818) and proximal (11,1% Vs 0%;p=0,0109) locations.Caesareans (13,3% Vs 8,7%;p<0,629),stillbirths (3,3% Vs 1,5%;p=0,9613) and congenital abnormalities (3,3% Vs 0,5%;p=0,6318) were more frequent in IBD /GI /AZT+ than in IBD/GI/AZT- but didn't reach SSD whereas abortions (6,6% Vs 5,2%),premature births (6,6% Vs 5,2%) ,low weight birth (10% Vs 8,2%) where found at the same rates UC/GI/AZT+ patients didn't differ from UC/GI/AZT-patients as regards to gestational complications.Caesareans(21,4% Vs 10,2%;p=0,4366),low weight births
(14,2% Vs 8,2%;p=0,814) and congenital abnormalities (7,1% Vs 0%;p=0,26) were more frequent in CD/GI/AZT+ than in CD/GI/AZT- patients .Long term outcome of the disease ,was evaluated according to 4 heading: unchanged, improved,worsened, need for surgery.We found no SSD between IBD/GI/AZT+ and IBD/GI/AZT-patients and between IBD/GI/AZT+ and IBD/ GII/AZT+ patients.
Use of AZT in IBD pregnant women is associated with a slight increase in fetal risk mainly in CD.This
pejorative effect cannot be entirely imputable to AZT as this drug is prescribed in severe IBD;in this instance, fetal outcome may be due at least in part to the disease activity.