Azathioprine exposure concerns raised for SLE mothers

Researchers have raised the possibility of an increased risk for developmental delay in the children of mothers who used azathioprine (AZA) for systemic lupus erythematosus (SLE) during pregnancy.

Their preliminary study examined the use of special educational services as a proxy for developmental delay among 60 children of 38 mothers with SLE.

Overall, 15 children were referred for special education, most commonly for speech delay. This included seven (54%) of 13 children whose mothers used AZA during pregnancy and eight (17%) of 47 children whose mothers had not, a significant difference.

AZA exposure during pregnancy was associated with a significant 6.6-fold increase in the need for special educational services in the children from age 2 years, after adjusting for confounding factors including pregnancy duration, small for gestational age, propensity scoring for lupus flare, lupus nephritis and corticosteroid use during pregnancy, maternal education, and antiphospholipid syndrome.

There was also a borderline significant increased risk for use of special education in children at any age and before age 2 years, report Emily Somers (University of Michigan, Ann Arbor, USA) and co-authors.

They note in Arthritis Care and Research that AZA is considered "relatively safe" in pregnancy and that studies have been unable to determine whether fetal complications reported during its use are related to the often poorly controlled underlying disease in the mother.

The authors therefore recommend prospective research to further investigate the possible link between in utero AZA exposure and developmental delay.

However, Somers et al write: "We wish to emphasize that immunosuppressive therapy should not be withheld in lupus pregnancies when indicated for treatment of active disease, as highly active lupus during pregnancy is associated with poor fetal outcomes, including increase in premature birth rates and decrease in live births.

"Our findings should alert pediatric providers to consider the need for early developmental screening of children born to mothers with SLE," they say, noting that early identification can improve long-term outcomes of children with developmental delay.

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