Document Detail


In utero azathioprine exposure and increased utilization of special educational services in children born to mothers with systemic lupus erythematosus.
MedLine Citation:
PMID:  23139238     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Azathioprine (AZA) is recognized among immunosuppressive medications as relatively safe during pregnancy for women with systemic lupus erythematosus (SLE) requiring aggressive treatment. This pilot study aimed to determine whether SLE therapy during pregnancy was associated with developmental delays in offspring.
METHODS: This cohort study included SLE patients with at least one live birth postdiagnosis. Medical histories were obtained via interviews and chart review. Multiple logistic regression was used to examine associations between SLE therapy during pregnancy and maternal report of special educational (SE) requirements (as proxy for developmental delays) among offspring. Propensity scoring (incorporating corticosteroid use, lupus flare, and lupus nephritis) was used to account for disease severity.
RESULTS: Of 60 eligible offspring from 38 mothers, 15 required SE services, the most common indication for which was speech delay. Seven (54%) of the 13 children with in utero AZA exposure utilized SE services versus 8 (17%) of 47 nonexposed children (P < 0.01). After adjustment for pregnancy duration, small for gestational age, propensity score, maternal education level, and antiphospholipid antibody syndrome, AZA was significantly associated with SE utilization occurring from age 2 years onward (odds ratio 6.6, 95% confidence interval 1.0-43.3), and bordered on significance for utilization at any age or age <2 years.
CONCLUSION: AZA exposure during SLE pregnancy was independently associated with increased SE utilization in offspring, after controlling for confounders. Further research is indicated to fully characterize developmental outcomes among offspring with in utero AZA exposure. Vigilance and early interventions for suspected developmental delays among exposed offspring may be warranted.
Authors:
Wendy Marder; Martha A Ganser; Vivian Romero; Margaret A Hyzy; Caroline Gordon; W J McCune; Emily C Somers
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis care & research     Volume:  65     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-24     Completed Date:  2013-06-17     Revised Date:  2014-04-11    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  759-66     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Azathioprine / adverse effects*
Child
Child, Preschool
Cohort Studies
Developmental Disabilities / diagnosis,  epidemiology*,  psychology
Education, Special / trends*
Female
Humans
Infant
Lupus Erythematosus, Systemic / drug therapy,  epidemiology*
Male
Pilot Projects
Pregnancy
Pregnancy Complications / drug therapy,  epidemiology*
Prenatal Exposure Delayed Effects / diagnosis,  epidemiology*,  psychology
Grant Support
ID/Acronym/Agency:
K01 ES019909/ES/NIEHS NIH HHS; K12 HD001438/HD/NICHD NIH HHS; K12HD001438/HD/NICHD NIH HHS; UL1 RR024986/RR/NCRR NIH HHS; UL1RR024986/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
MRK240IY2L/Azathioprine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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