Medication during pregnancy and breastfeeding

[Kerry]

Hi,
I was diagnosed with crohns of the colon a year ago - what a shock tha was. I tried prednisole but was bed bound Jan and Feb this year so have been on infliximab since then and doing well. Im on 8 week infusions. I did have an iron infusion in feb but havent had to have another.

I took Azathioprine for about 3 weeks in early Jan and felt terrible so i stopped. I thought i was feeling bad because i had come off the steroids but it turned out i was going into a major flare so were not sure if i felt bad on aza because of aza or because of the flare.

I have done 2 courses of IVF since april and am now 11 weeks pregnant - woohoo!! I saw a consultant last week and he was awful. Said i was a very complex case with bad crohns and he was just a stand in for my normal consultant so he would talk to her. Well that cheered me up as you can imagine. I dont think my crohns is that bad as Ive had no operations and am in remission. Anyway they have since written to me and i can only have the infliximab up to 24 weeks. well i had my last infusion 1 day before 8 weeks so ill have another at 1 day before 16 weeks and another at 1 day before 24 weeks. Then stop. They want me to start on Aza from 12 weeks which is next week. 50 soemthing for a week, then 100 then 150.

They say i can breast feed with aza even though the manufacturers say not to.

Ive been to hell and back to get to being pregnant so im a bit nervous. I wander what im putting my poor baby through with all these drugs.

Also if i start Aza at 12 weeks it will be in my system by 24 weeks wouldnt it so maybe i wouldnt need the 24 week infusion?

I saw a crohns nurse a few weeks back at my infusion and she said they wouldnt start me on aza whilst pregnant. So im confused.

Just after some reassurance if anyone has been on aza whilst pregnant and even started it whilst pregnant. I know theres a theoretical risk to baby if you take it in the first 3 months and thats why they left me on infliximab as i was doing IVF. Apparently there confident Aza is OK with a normal conception but not tested with IVF.

Sorry - long story. Just after some reasurance. Im trying to look on the positive side that i wont have to go to hospital every 8 weeks for an infusion and instead just pop some pills. I hate this disease so much as i never even took headache pills before i got it.

 

[Aussie]

Hi Kerry, in regards to medications in pregnancy:

1. AZA is perfectly safe in pregnancy! By far the biggest risk to the baby is having a flare of Crohns during pregnancy.

2. Infliximab is actively transported across the placenta in the third trimester (that's why you're stopping it at week 24). Although, if there is a big risk of flare by stopping, some people will continue throughout pregnancy (if this happens, ensure no live vaccines for baby, like the BCG, for the first 6 months).

3. In regards to breastfeeding, recent change in practice. Some will allow breastfeeding without restriction. Given AZA is absorbed into the breastmilk upto 4 hours after taking, a reasonable compromise would be to take your AZA last thing at night, first thing in the morning pump your breastmilk and discard, and then breastfeeding normally.

4. If you do flare while pregnant, then prednisone reasonably safe. Small risk of cleft lip if given in first trimester, and small risk of premature rupture of membranes.

Good luck!

 

[Kerry]

Aussie

Thanks for that. very useful.

I still have a question about the infliximab. I know i can take it at week 23 and 6 days but then it will in my system until at least week 31 and 6 days. Im currently on 8 week infusions and i dont get symptoms before the 8 weeks so i assume its still working at that point.
I understand trimester 3 starts at week 27 so i will still have the infliximab in my system then. Is that correct that i can still have it?

Thanks again

 

[Aussie]

Hi Kerry, you can still have the Infliximab, however any Infliximab you have in your system can potentially be transferred across the placenta in the third trimester, that being said, it is only in tiny amounts, and the less in your system at that time, the less transferred.

Recent PIANO trial from US followed around 1100 women with IBD for 1 year after giving birth, some on treatment, some not, and looked at outcomes. Essentially treatments very safe, no increased birth defects, slightly increased risk of infections in the biologic group (when excluding Cimzia, which doesn't cross the placenta).

Most important message is that any medication (with the exception of methotrexate and
thalidomide) is much safer than the risk of a Crohns flare with stopping treatment.

Best wishes.

 

[Rebecca85]

Hi, I am currently 36 weeks pregnant, taking azathioprine, and planning on breastfeeding. The latest info on aza suggests that although it is excreted in breastmilk in some (not all) women, it is in tiny amounts, and there appears to be no long term effects (think they followed a group of babies up till 5 years old). I will post a link to the latest studies if I can find them again.

I haven't had any pregnancy complications that can be attributed to either Crohn's or aza. I have been under consultant care, as babies of women with Crohn's are at risk of being underweight, but it turns out I have gestational diabetes (diabetes runs on my family) so baby is definately not small!

 

[Rebecca85]

Here's one study http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2006.01232.x/full

And another http://www.ecco-jccjournal.org/article/S1873-9946(10)00193-5/abstract