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. 2023 May 3;17(5):738-745.
doi: 10.1093/ecco-jcc/jjac183.

Exposure to Thioguanine During 117 Pregnancies in Women With Inflammatory Bowel Disease

Femke Crouwel  1 , Melek Simsek  1 , Marjon A de Boer  2 , Chris J J Mulder  1 , Emma M van Andel  3 , Rob H Creemers  4 , Dirk P van Asseldonk  3 , Ad A van Bodegraven  1   4 , Carmen S Horjus  5 , Marijn C Visschedijk  6 , Angelique L M Weusthuis  7 , Margien L Seinen  8 , Bindia Jharap  9 , Fiona D M van Schaik  10 , Ishfaq Ahmad  11 , Paul J Boekema  12 , Greetje J Tack  13 , Louktje Wormmeester  14 , Maurice W M D Lutgens  15 , Petra G A van Boeckel  16 , Lennard P L Gilissen  17 , Marjon Kerkhof  18 , Maurice G V M Russel  19 , Frank Hoentjen  20   21 , Maartje E Bartelink  7 , Johan P Kuijvenhoven  22 , Jeroen W J Maljaars  23 , Willemijn A van Dop  20 , Janneke Wonders  24 , Michael M P J A van der Voorn  24 , Hans J C Buiter  25 , Nanne K de Boer  1
Affiliations

Exposure to Thioguanine During 117 Pregnancies in Women With Inflammatory Bowel Disease

Femke Crouwel et al. J Crohns Colitis. .

Abstract

Background: Safety of thioguanine in pregnant patients with inflammatory bowel disease [IBD] is sparsely recorded. This study was aimed to document the safety of thioguanine during pregnancy and birth.

Methods: In this multicentre case series, IBD patients treated with thioguanine during pregnancy were included. Data regarding disease and medication history, pregnancy course, obstetric complications, and neonatal outcomes were collected.

Results: Data on 117 thioguanine-exposed pregnancies in 99 women were collected. Most [78%] had Crohn's disease and the mean age at delivery was 31 years. In 18 pregnancies [15%], IBD flared. Obstetric and infectious complications were seen in 15% [n = 17] and 7% [n = 8] of pregnancies, respectively. Ten pregnancies [8.5%] resulted in a first trimester miscarriage, one in a stillbirth at 22 weeks of gestational age and one in an induced abortion due to trisomy 21. In total, 109 neonates were born from 101 singleton pregnancies and four twin pregnancies. One child was born with a congenital abnormality [cleft palate]. In the singleton pregnancies, 10 children were born prematurely and 10 were born small for gestational age. Screening for myelosuppresion was performed in 16 neonates [14.7%]; two had anaemia in umbilical cord blood. All outcomes were comparable to either the general Dutch population or to data from three Dutch cohort studies on the use of conventional thiopurines in pregnant IBD patients.

Conclusion: In this large case series, the use of thioguanine during pregnancy is not associated in excess with adverse maternal or neonatal outcomes.

Keywords: Inflammatory bowel disease; pregnancy; thioguanine.

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Conflict of interest statement

FC, MAdB, CJJM, EMvA, RHC, CSH, MCV, ALMW, MLS, BJ, IA, PJB, GJT, LW, MWMDL, PGAvB, MK, MGVMR, FH, MEB, WAvD, JW, MMPJAvdV and HJCB have nothing to declare. MS has received an unrestricted research grant from TEVA. DPvA served as speaker, adviser, and/or ­principal ­investigator for Dr Falk, Ferring, Galapagos/Gilead, and Takeda, and received research grants from Janssen and Dr Falk. AAvB served as speaker, adviser, and/or principal investigator for AbbVie, Arandal, Arena Pharmaceuticals/Pfizer, Celgene, Ferring, Galapagos/Gilead, Janssen/Johnson and Johnson, Merck Sharpe & Dohme, Pfizer, Receptos, Roche, Takeda, TEVA, Bristol Myers Squibb, and received research grants from TEVA, Eurostars funding, ZonMW, and Pfizer. FDMvS served as adviser for Takeda, Galapagos, and Dr Falk. LPLG has served as a speaker for AbbVie and Boston, and received a grant from Ferring to develop e-learning about therapeutic drug monitoring. JPK has served as an adviser for AbbVie and Janssen/Johnson & Johnson. PWJM has served as a speaker for Janssen, Galapagos, and Takeda, and received research grants from Galapagos and Takeda. NKdB has served as a speaker for AbbVie and MSD, has served as consultant and principal investigator for TEVA Pharma BV and Takeda, and received unrestricted research grants from Dr. Falk, TEVA Pharma BV, MLDS, and Takeda.

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