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P217 The relationship between thiopurine use during pregnancy and anemia in the offspring during the first year of life

Shitrit A.B.-G.*1, Granovsky-Grisaru S.2, Goldin E.3, Koslowsky B.3

1Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem, Israel 2Shaare Zedek Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Jerusalem, Israel 3Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem, Israel

Background

Thiopurines are given safely to patients with inflammatory bowel diseases (IBD). Repeated studies did not show a connection between thiopurine exposure in pregnancy to major teratogenic outcomes. Anemia has recently been shown to be found more commonly in children born to pregnant IBD patients exposed to thiopurines during pregnancy. The aim of this study was to assess the relationship between thiopurine exposure during pregnancy to development of anemia in their offsprings during the first year of life.

Methods

A prospective comparative observational study was performed at an IBD clinic dedicated for pregnant women. All IBD patients who gave birth between 2009–2015 were allocated. Only patients who were treated exclusively by thiopurines both at pregnancy onset and throughout pregnancy were included in the study arm. The control group consisted of IBD patients not medically treated during pregnancy. The hemoglobin level was performed during the first year of life. Both groups were also compared to the expected hemoglobin levels during the first year of life.

Results

Altogether 34 patients (21 study group and 13 controls) were analyzed. Median years of thiopurine use prior to pregnancy was 24 months (range 12–72 months) and average dosage was 98 mg (range 50–175 mg). Median age of the study group was 32 compared to 29 in the control group (p=0.02). Mean years of disease prior to birth was 9.5±4.9 in the study group vs. 4.3±5 in the controls (p=0.008). IBD activity, use of either oral iron or intravenous iron as well as the presence of iron deficiency during pregnancy were all similar between both groups. Mean Hemoglobin (G/dL) in the study group compared to the control group was 11.8±0.8 vs. 11.5±0.6 (p=0.81). The white blood count (109/L), platelets (109/L), mean corpuscular volume (MCV) and red cell distribution width (RDW) were 12.2, 355, 75 and 15 in the study group compared to 12.4, 396, 75 and 15 in the control group, respectively (p=0.89, p=0.26, p=0.3, p=0.46 for each of the comparisons).

Conclusion

The use of thiopurines during pregnancy in IBD patients is not correlated with anemia in the newborn during the first year of life. Thiopurines continue to show high levels of safety during pregnancy.