<i>In utero</i> exposure to thiopurines/anti‐TNF agents and long‐term health outcomes during childhood and adolescence in Denmark

supporting

confidence: 78%

“…The authors declarations of personal and financial interests are unchanged from those in the original article 2 …”

Section: Acknowledgementmentioning

confidence: 99%

Editorial: thiopurine/anti‐TNF use during pregnancy—more encouraging safety data. Authors' reply

Nørgård

Friedman

2020

“…In addition, we adjusted for several confounding factors but unknown confounding cannot be ruled out in an observational study like this. Furthermore, anti‐TNF medications have been used to treat similar diseases and have been studied to some extent 1,43,44 . Since these medications are much newer, the long‐term consequences in the offspring may not be possible to detect at present and it will take several years until a full long‐term effect of biologics can be examined 45 .…”

Section: Discussionmentioning

confidence: 99%

“…In general, data on the long‐term health outcomes in the offspring are sparse. Considering health outcomes in children older than 1 year, only cognitive and neurodevelopmental aspects, infections, malignancies and hospitalisations have been examined 1,24,26‐29 . However, no studies have elucidated the risk of some of the most prevalent chronic diseases in a young population in the Nordic countries, 30 including type 1 diabetes mellitus, coeliac disease, thyroid disease, rheumatoid‐ and juvenile arthritis, IBD including Crohn's disease and ulcerative colitis and asthma and bronchitis during childhood and adolescence.…”

Section: Introductionmentioning

confidence: 99%

The risk of chronic diseases and congenital malformations during childhood and adolescence after in utero exposure to thiopurines

Jølving

Anru

Nielsen

et al. 2021

Self Cite

Summary Background Women with autoimmune diseases, particularly inflammatory bowel disease (IBD), often need to continue immunomodulatory therapies during pregnancy. While the evidence of birth and short‐term outcomes in children exposed in utero to these medicines is reassuring, long‐term safety data are lacking. Aim To assess any association between in utero exposure to thiopurines and diagnoses of chronic diseases (type 1 diabetes, coeliac disease, thyroid disease, rheumatoid arthritis, IBD and asthma) and congenital malformations during childhood and adolescence. Methods This nationwide cohort study was based on information using Danish registers and comprised all live‐born children from 1995 to 2015 (N = 1 308 778). Children exposed in utero to thiopurines were followed for a median of 8.9 years (25%‐75% percentiles 5.5‐12.4 years); children not exposed were followed for 13.9 years (25%‐75% percentiles 8.7‐19.0 years). Analyses were adjusted for a number of confounders including the type of maternal underlying disease. Results A total of 1047 children had been exposed to thiopurines in utero; 96 developed a chronic disease and 126 were diagnosed with congenital malformations during follow‐up. The adjusted hazard ratio for rheumatoid arthritis was 0.78 (95% CI 0.35‐1.73); for IBD, it was 1.45 (95% CI 0.64‐3.27); for asthma 0.94 (95% CI 0.73‐1.21), and for congenital malformations, it was 0.95 (95% CI 0.78‐1.15). For type 1 diabetes, coeliac disease, thyroid disease and ulcerative colitis, we had insufficient data to perform adjusted analysis. Conclusion We found no increased risk of seven common chronic diseases or congenital malformations during childhood and adolescence after gestational exposure to thiopurines.

“…The recent study by Norgaard reports on infections in children less than 1 year and those 1‐3 years of age, then long‐term child health outcomes including psychiatric diagnoses, Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and malignancies 7 . Important findings included lack of any significant increase in risk for infections in children exposed to thiopurines in the first 3 years of life (OR 0.91, 0.77‐1.07).…”

mentioning

confidence: 99%

Editorial: thiopurine/anti‐TNF use during pregnancy—more encouraging safety data

Chowdhury

Kane

2020