Azathioprine and pregnancy

I was just wondering if anyone had been in the same situation as me. I was diagnosed with crohns disease in April 2011. My blood tests were fine up until summer last year. I fell pregnant in October and was told my folic acid levels were low so was prescribed 500mg of folic acid, I miscarried at 8 weeks in November. Was told that azathioprine was fine to take when pregnant so was told to carry on trying. Fell again in march and miscarried in April at 6 weeks. To which I was told at my last blood work that my WBC had dropped to below 4.0 so to discontinue my azathioprine to which I did and iv never felt better. Started taking it again on wednesday and have felt rotten since then. Went back to doctors yesterday and they told me that azathioprine does cause risks to an unborn feotus. Of course I was not impressed as was told that azathioprine does not affect an unborn child! I'm left baffled as weather it does or not. But my view is if my bloods are all over The place then that's not good gettin passed on to a baby. I have asked for a change of medication as I feel that risk outweightls benefit in my body and I don't want to have to go through another miscarriage. Anyone else share a similar story?

These are the Pregnancy Categories for Drugs: http://www.crohnsforum.com/wiki/Pregnancy-Categories-for-Drugs

Azathioprine: Pregnancy Category D
"There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."

I'm sorry if I can't be of more help than that as I've never been pregnant nor have I taken Aza.

Edit: This thread deals with Aza and pregnancy: http://www.crohnsforum.com/showthread.php?t=14534

Hi,
I fell pregnant whilst I was taking Azathioprine. I decided to stop the Azathioprine when I found out, against the GI doctors advice, but I had a wonderful pregnancy. I find that the pregnancy hormones keep my Crohns in check. My daughter was born healthy, thank god.
I am so sorry you have suffered miscarriages - I suffered one, and the heartache was horrendous.
There is so much conflicting views with Azathioprine and pregnancy. I feel that the Azathioprine helped me keep my Crohns in check, so that my body was healthy enough to conceive, but I didn't feel comfortable taking in whilst pregnant, and am grateful that during my pregnancy I had no problems.
I would definitely continue with the folic acid. Best of luck to you x

Thanks deb123, it's nice to get a response from someone who has went through the same. Do you think the azathioprine had something to do with your miscarriage? I don't know what to think as all doctors give you different advice. But while I was pregnant none of them seemed to take my crohns and azathioprine into account! X

Just found this vicky130792.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- When used during pregnancy azathioprine may increase the risk of premature birth, low birth weight and miscarriage. It may also decrease blood cell counts in the baby. It should not be used during pregnancy unless the benefits of the medicine outweigh any potential risks to the baby. Seek further medical advice from your doctor.

- Women who could get pregnant should use effective contraception to avoid pregnancy and men should use effective contraception to avoid fathering a child during treatment with this medicine. Women who do get pregnant while they or their partner is receiving treatment should consult their doctor immediately.

- This medicine passes into breast milk. Women who need treatment with this medicine should not breastfeed. Seek further medical advice from your doctor.

http://www.netdoctor.co.uk/seniors-health/medicines/imuran.html

Thank you for your support. I just don't know what to do! So many different views on azathioprine. I know I have no problem gettin pregnant as I have fell twice between October last year and march this year. Any more advice would be appreciated! Thanks x

Hi Vicky,
just to clarify that I wasn't taking azathioprine when I miscarried. I wasn't on any medication, as I was in remission. I later fell pregnant with my eldest daughter who is now 16, and the pregnancy hormones kept me in remission. I flared when my first baby was 6 months, tiredness and stress I guess!
I then tried to conceive about 2 years later, but no joy. My GI said that I would have fertility issues whilst my Crohns was unpredictable, but mild. I was on azathioprine as a maintenance drug, and I didn't fall pregnant until 5 years later!! I had given up hope!
I immediately stopped my azathioprine, as I didn't feel comfortable taking it.
I think you have to do whats best for you. My Crohns was mild, no surgery, abscesses, fistulas nothing.
As Jenifer said you have to weigh up the benefits of the medicine in your pregnancy. Please remember that a lot of women find their condition improves with pregnancy. I would stay pregnant forever, as I felt wonderful!
Good luck with your decision, listen to your body, and talk to your doctors x

Thanks. Well my body says no, but doctors seem to say either. One doctor said there was no chance azathioprine would harm a baby but my other doctor said there was no way he should have said that as there is many risks. I have asked to change medication but azathioprine works fine for me. Well did until I had to come off for a week as my bloods were all over the place. So don't know if I want to risk changin it as I feel comfortable at the moment. But if it's goin to cause problems with pregnancy and other things I don't think it's worth it. I haven't seen or spoke to a crohns specialist since last august. Nobody really took my crohns into account when I was pregnant or even checked my bloods more regular. I also thought with have such disease I would get tested for reasons for the miscarriage but no, they still said 3 before i can get tests. Really annoys me as they don't care where I'm from and don't even offer you support. I'm lucky iv got a caring family and friends or I would have never got over the miscarriages because I got no support from doctors or midwives!
X

I was devastated when I was told that I had Crohn's because I was told a few months before that we were able to TTC!! The Crohn's hit and everything was out of wack. After several GI appointments I had a very serious conversation with my GI (the same one I had with my GYN the following week). Everyone together has agreed that remicade is my next best step. Both the GI and GYN cautioned the use of Azathioprine. I was also told not to try right now. I am flaring (Who wants to TTC when you’re in a flair...talk about the most unsexy feeling in your whole life anyway) but will start remicade next week. The GI told that Azathioprine would be ok while we TTC but as soon as I was pregers they would have to pull me off and put me on Remicade. However, my GYN was very strongly against the use of azathioprine even while we TTC. Everyone involved felt the right thing to do was simply skip the azathioprine.
Good luck to you! Crohn’s and conception is always in the back of my head. I wish you the best!
:hug:

I am currently 6 months pregnant and Iveta taken Azathioprine and mesalaine for the whole pregancny. Ive also had a flare up a d have been talking Prednisolone for the last two months. Scans show baby is fine and growing well. I was also very lucky and got pregnant straight awyay. Both my GILL and Obstetrician are věry content that these drugs are safe. The risks associated wit Azathioprine are small ...some evidence to suggest it could effect growth later on in prenancy but this čsn be seperated from the effect ofhavg Crohns..i.e if the Crohns is active u absorb legs nutrients and therefore the baby does not grow. All the advice Iv had which has been consistent with every healthcare professional os that its much safer to také it and rem ain in remission. So Im happy wit that. The thing is this drug has been used for years on lots of pregnant women for a range of diseases and thats why they can be so confident about it. Im also planning to breastfeed whlsti on it. I hope thing work out for u soon. Best of luck x

Ps Sorry about the awful spelling...I'm on my phone!

Thank yous! Have any of yous had your blood tests back saying most of your levels are low? It seems when I'm pregnant all my levels go low and I end up miscarrying. I haven't seen a multidisciplinary team atall. Just a midwife then my nurse for bloods. Never seen a Dr the whole time I was pregnant, nor a crohns specialist or obseratrian or gynocologist. No support has been given to me what so ever! I tried to make appointments myself but got told there was noappointments until months after, wwhich was no use to me! I haven't had a flare up since before I was put on azathioprine luckily but my bloods have been all over The place. Even on my week off of the medication last week I felt fine. Until I started takin it again and I feel drained sick and just want to sleep all the time. My Dr said he doesn't have the power to change my medication but he told me if I don't start to loose the side affects then to come off it. To me if he doesn't have the power to change my meds he shouldn't really be tellin me to come off it if I still don't feel right when it's such a leathal drug! And also I have no other medication to fall back on. My cousin also has crohns and takes pantesa and has had one healthy little boy and is pregnant with her third. But it all depends on the severity of the crohns. I'm angry that the drs who put me on azathioprine didn't bother explainin all of this when I was 17 or I would never have agreed to go on the drug. They seem to forget at some point in your life you want children and don't bother tellin you about it. X

Pregnant with her second, sorry!

Oh dear it sounds like you are not getting the support you need at all. You definatley need to see a Gastroenterologist, as GP's really do not know how to manage Crohn's long term. If the Azathioprine is effecting your blood count so much it sounds like you should come off it but only under the supervision of a consultant I would say. There are lots of alternative drugs they can try you on, Azathioprine is certainly not the only thing, but again it would be a consultant that would discuss that with you. It sounds like the Azathioprine has been keeping your Crohn's under control if you have never had a flare up whilst on it so it seems a shame to just stop all treatment and risk having a flare up. The advice I was given was you are less likely to get pregnant whilst flaring and you are at risk of problems if you flare up during pregnancy (which is why they put me on steroids straight away at the first sign of any problems).

I have not had any problems with my blood count whilst on Azathioprine but my consultant monitors it closely and I have a blood test every month. I am very lucky as I see a Gastroenterologist privately as I have health insurance, so I see him whenever I like. Perhaps if you can consider seeing someone privately as you will get in Straight away..even if its just a one off to get a second opinion. My consultant costs £150 per consultation. I see an Obstetrician on the NHS and I was referred to them by my midwife. However I didn't meet them until my 12 week scan.

Good luck with getting the right support and care. I really think you need to get your medication under control/working for you before a pregnancy. I know how hard that is as we wanted to start trying for a baby but ended up waiting over a year before things had settled with the medication etc. You will get there in the end.