Once my body had settled down thanks to Azathioprine (AZA), my husband and I wanted to try to have a baby. I was advised to stop AZA because it is a class D drug that would more than likely cause a birth defect. After 6 months off AZA, I had a flare and had to go back on the drug. I was told it was probably best not to have children since I couldn’t get off AZA.
Heartbroken and not willing to give up our dreams so quickly, I started reading journal articles again so we could make an informed decision. After reading the studies on AZA and pregnancy we decided to try to conceive while I was on AZA and then immediately stop once we found out I was pregnant. Everything did turn out well. We have a perfectly healthy boy and I luckily stayed in remission while pregnant even off AZA. However, four weeks after giving birth I did flare again and had to be put back on AZA. There is no way to know if pregnancy will put a patient in remission or cause a more serious flare. It was a risk that we took and trusted God would protect us. Below are some articles that may help you and your doctor make an informed decision or at least help you ask questions.
A Danish study in 2003 claimed an increase in birth defects in women taking AZA. The study looked at 10 pregnancies.
Azathioprine, mercaptopurine and birth outcome: a population-based cohort study
In 2007, the same authors of the 2003 Danish study published another articles using a larger study population of 76 pregnancies. They still noted increased birth defects in their study, but this time they compared the results to people with the same disease but not taking AZA and concluded that the birth defects were more likely caused by the disease itself and not AZA.
Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: A Danish nationwide cohort study
This next article states that AZA does cross the placenta, however only the inactive form of AZA crosses the placenta. The fact that the active form of AZA, 6-MP, does not easily cross the placenta protects the fetus from the effects of AZA during the early months of pregnancy because the fetus’s liver is not formed enough to convert AZA into 6-MP.
In utero exposure to immunosuppressive drugs
Three cases of successful pregnancies with healthy babies born to mothers who continued AZA therapy throughout their entire pregnancies. Both the mother’s and baby’s blood were tested for 6-MP after delivery. The mothers were found to be therapeutic and all three babies had undetectable amounts of 6-MP.
Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites
This article gave us the most confidence in conceiving while on AZA. The above articles were all foreign studies, but the following article was authored by researchers at Mount Sinai in New York. It looked at a much larger group of patients, 155 pregnancies with some exposure to AZA. The study results concluded that the birth defect rate among AZA users was the same as the national average. It also pointed out the reported birth defects were all different. There was not a single consistent birth defect among the babies.
The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study
Welcome
I have suffered from autoimmune disease since the age of 17 and I have several relatives who are also fighting autoimmune diseases. I have been diagnosed with Autoimmune Hepatitis (AIH), Lupus, and the Antiphospholipid Syndrome (APS). Family members have been diagnosed with Rheumatoid Arthritis, Dermatomyositis, Grave’s, Hashimoto’s, Vitiligo, and Type I Diabetes.
In the search for my diagnosis, I have seen doctors in six states, from every medical specialty, seven of whom were Rheumatologists. I had an extremely difficult time finding a doctor to take my symptoms seriously because most of my blood work was normal and I did not look sick. I have a Master’s degree in Aerospace engineering and solve puzzles for a living as a systems analyst. I resorted to reading medical journal articles to try to put my own pieces together when the doctors were finished looking. I ended up being a very complicated case and had the unfortunate luck to end up with the rarest and oddest of symptoms, as if all autoimmune symptoms aren’t bizarre enough! It took me 13 years to finally find a doctor who understood my body.
As a result of my search for a diagnosis, I’ve learned a lot about the immune system, doctors, and the medical system. I’ve been asked by numerous people who have heard my story how did I find out certain facts, or how did I find a certain doctor because they also have a friend who the doctors don’t seem to be able to help? Over time, I’ll post all the knowledge I’ve gained over the years, to give someone else having troubles obtaining that elusive diagnosis some other options to consider when you hit a brick wall.
Email: autoimmunediagnosis@gmail.com
In the search for my diagnosis, I have seen doctors in six states, from every medical specialty, seven of whom were Rheumatologists. I had an extremely difficult time finding a doctor to take my symptoms seriously because most of my blood work was normal and I did not look sick. I have a Master’s degree in Aerospace engineering and solve puzzles for a living as a systems analyst. I resorted to reading medical journal articles to try to put my own pieces together when the doctors were finished looking. I ended up being a very complicated case and had the unfortunate luck to end up with the rarest and oddest of symptoms, as if all autoimmune symptoms aren’t bizarre enough! It took me 13 years to finally find a doctor who understood my body.
As a result of my search for a diagnosis, I’ve learned a lot about the immune system, doctors, and the medical system. I’ve been asked by numerous people who have heard my story how did I find out certain facts, or how did I find a certain doctor because they also have a friend who the doctors don’t seem to be able to help? Over time, I’ll post all the knowledge I’ve gained over the years, to give someone else having troubles obtaining that elusive diagnosis some other options to consider when you hit a brick wall.
Email: autoimmunediagnosis@gmail.com
Medical Disclaimer
This website is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients should review the information with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Remember I’m a rocket scientist not a doctor.
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