Coelho J, Beaugerie L, Colombel JF et al.; CESAME Pregnancy Study Group (France). Gut 2011;60:198–203.
In this cohort study from France, pregnancy outcomes in women with IBD who were treated with thiopurines were examined. There was no difference in the numbers of live births, prematurity, birth weight, rate of low birth weight, and number of congenital abnormalities between those who received thiopurines alone, another drug, and no drug. The complication rate during pregnancy or postpartum was also not different between the treatment and no treatment groups.
The safety of using thiopurines in women with IBD who are pregnant is not well substantiated. The CESAME (Cancers et Sur-risque Associé aux Maladies Inflammatoires Chroniques Intestinales en France) database investigators followed 11 006 women with IBD from 2004–2007 in France. Pregnancies (215 in 204 women) were classified into three groups according to drug exposure. Group A included pregnancies in women exposed to thiopurines (n=86). In 57 of these women, thiopurines was the only therapy used. Group B included pregnancies in women receiving a drug other than thiopurines (n=84). Group C included pregnancies in women not receiving any therapy (n=45). Of the women with pregnancies, 76% had Crohn’s disease. Live births occurred in 64% of pregnancies and there were four sets of twins. The rates of live births and birth defects were not different than what was expected from a healthy population. However, prematurity and a low birth weight were more common than expected, which may reflect the disease as much as the thiopurine treatment. There was no statistical difference between the three groups for numbers of live births, prematurity, for birth weight, low birth weight (<2500 g), and number of congenital abnormalities. The complication rate during pregnancy or postpartum was not different between the three groups.