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A retrospective study of anaemia in neonates exposed to thiopurines in utero
  1. Kate Wiles1,
  2. Manju Chandiramani2,3,
  3. Sabrina Jiwani4,
  4. Catherine Nelson-Piercy5,6
  1. 1Women's Health Academic Centre, St Thomas’ Hospital, London, UK
  2. 2Parturition Research Group, Hammersmith Hospital, London, UK
  3. 3Department of Obstetrics and Gynaecology, West Middlesex University Hospital, London, UK
  4. 4King's College London Medical School, c/o Women's Health Academic Centre, St Thomas’ Hospital, London, UK
  5. 5Guy's and St Thomas’ NHS Foundation Trust, London, UK
  6. 6Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Kate Wiles, Women's Health Academic Centre, 10th Floor, North Wing, St Thomas’ Hospital, London SE1 7EH, UK; kate.wiles{at}kcl.ac.uk

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Thiopurines, including azathioprine and mercaptopurine, have a good safety record in pregnancy.1–3 Meta-analysis shows that maternal thiopurine use is not associated with either congenital abnormality or low birth weight.1 A positive association with preterm delivery has been attributed to the severity of the underlying condition for which thiopurine use acts as a surrogate marker.1 However, Jharap et al suggest that all infants exposed to thiopurines in pregnancy should be routinely tested for anaemia. This conclusion is based on a subgroup analysis of only 16 infants, a median ‘anaemic’ haemoglobin of 14.9 g/dL, which lies within the 95% reference range, and a statistically insignificant correlation between thiopurine metabolite concentration and anaemia.4

We challenged this recommendation by undertaking a retrospective cohort study of pregnant women receiving thiopurine therapy …

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