Schwangerschaft unter immunsuppressiver Therapie – Ein Fall mit glücklichem Ausgang

Die aktuellen Warnhinweise zu Missbildungen bei Kindern, deren Mütter während der Schwangerschaft Mycofenolatmofetil eingenommen haben, zeigen, wie aufmerksam das Thema immunsuppressive Therapie und Schwangerschaft weiterhin betrachtet werden muss. Wir stellen den Fall einer 32–jährigen Patientin mit Morbus Crohn vor, die unter einer Azathioprintherapie schwanger geworden war. Die Therapie wurde fortgesetzt, der Krankheitsverlauf war stabil, und die Patientin brachte einen gesunden Jungen zur Welt. Dennoch muss unter immunsuppressiver Therapie eine suffiziente Kontrazeption weiterhin vorbehaltlos empfohlen werden. Sollte es trotzdem zu einer Schwangerschaft kommen, kann der behandelnde Arzt jedoch inzwischen in enger Kooperation mit dem Pränatalmediziner häufig eine Interruptio vermeiden.

Present warnings of malformations that may occur in children whose mothers had taken the immunosuppressant mycofenolatmofetil during pregnancy demonstrate the great need to keep a close watch on the possible effects of immunosuppressive therapy during pregnancy. We present the case of a 32–year old female patient suffering from Crohn's disease who became pregnant while undergoing azathioprine therapy. Therapy was continued; the course of the disease remained stable and the patient gave birth to a healthy male. Inspite of this fortunate outcome we must continue to recommend without prejudice satisfactory contraceptive measures if the patient is undergoing immunosuppressive treatment. However, in case pregnancy does occur, the physician may often prevent an interruption of the pregnancy in close co–operation with the prenatal physician.

Key words

Crohn's disease - Crohn's colitis - immunosuppression - azathioprine - pregnancy

Literatur

• 1 Steinlauf AF, Present DH.. Medical management of the pregnant patient with inflammatory bowel disease.  Gastroenterol Clin North Am. 2004;  33 361-385
• 2 Al AF Hadithy, de NK Boer, Derijks LJ, Escher JC, Mulder CJ, Brouwers JR.. Thiopurines in inflammatory bowel disease: Pharmacogenetics, therapeutic drug monitoring and clinical recommendations.  Dig Liver Dis. 2005;  37 282-297
• 3 Rosenkrantz JG, Githens JH, Cox SM, Kellum DL.. Azathioprine (Imuran) and pregnancy.  Am J Obstet Gynecol. 1967;  97 387-394
• 4 Githens JH, Rosenkrantz JG, Tunnock SM.. Teratogenic effects of azathioprine (Imuran).  J Pediatr. 1965;  66 959-961
• 5 De Boer NKH, Jarbandhan SVA. et al. . Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites.  Am J Gastroenterol. 2006;  101 1390-1392
• 6 Langagergaard V, Pedersen L, Gislum M. et al. . Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: a Danish nationwide cohort study.  Aliment Pharmacol Ther. 2007;  25 73-81
• 7 Bortoli A, Saibeni S, Tatarella M. et al. . Pregnancy before and after the diagnosis of inflammatory bowel diseases: retrospective case–control study.  J Gastroenterol Hepatol. 2007;  22 542-549
• 8 Kallen K.. The effect of maternal smoking during pregnancy on outcome of pregnancy.  Eur J Public Health. 2001;  11 329-333
• 9 Misra DP, Astone N, Lynch CD.. Maternal smoking and birth weight: interaction with parity and mother's own in utero exposure to smoking.  Epidemiology. 2005;  16 288-293
• 10 Dewit O, Vanheuverzwyn R, Desager JP, Horsmans Y.. Interaction between azathioprine and aminosalicylates: an in vivo study in patients with Crohn's disease.  Aliment Pharmacol Ther. 2002;  16 79-85
• 11 Mottet C, Juillerat P, Gonvers JJ. et al. . Pregnancy and Crohn's disease.  Digestion. 2005;  71 54-61

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