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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 …
Contributors CN-P conceived and designed the study. MC, SJ and KW acquired the data and undertook the analysis and interpretation. All authors jointly contributed to writing and editing the manuscript for submission.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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