Lupus Rx In Utero Tied to Learning Issues

Azathioprine for lupus during pregnancy associated with developmental delays in kids

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Azathioprine therapy for lupus is generally considered safe during pregnancy. But children exposed to azathioprine in the womb may be at higher risk of developing speech problems.

A recent study found that children of mothers treated with azathioprine (brand name Imuran) during pregnancy were more likely to require special education services, a sign of developmental delay.

"Tell your prenatal care provider about any medications you're taking."

This study was conducted by Wendy Marder, MD, of the Division of Rheumatology at the University of Michigan in Ann Arbor, and colleagues. The objective was to find out if treating lupus, medically known as systemic lupus erythematosus (SLE), with azathioprine during pregnancy would lead to development delays in offspring. 

The researchers conducted a preliminary retrospective study on 60 children of 38 mothers with lupus. The use of special educational services was used as a measure of developmental delay. After selecting the study participants, the authors obtained medical histories via interviews and chart review. The median age of the kids at the time of the study was 5.7 years.

Of the study participants, mothers of 13 children used azathioprine during pregnancy and the remaining 47 children were not exposed to azathioprine in the womb.

Of the 13 children exposed in the womb, seven (54 percent) were referred to special educational services, primarily for speech delay. In comparison, eight (17 percent) of the unexposed children were referred to special education.

The authors conducted statistical analysis to show that this difference was significant. No significant differences were found in maternal age, race or level of education between mothers of the children in the groups that received special education and those that did not.

In summary, the study found that children who had azathioprine exposure in the womb were 6.6 times more likely to require special education services than unexposed children. This risk was significantly increased in children older than 2 and borderline increased in children 2 years old or younger.

The authors accounted for other factors such as duration of pregnancy, fetus size, corticosteroid therapy during pregnancy, education of the mothers and other lupus-related disorders.

Since the study was conducted on a relatively small population, the authors recommended prospective studies to validate the results before concluding that azathioprine exposure in the womb could be directly responsible for the developmental delays observed.

The authors emphasized that the findings are not strong enough to warrant restricting immunosuppressive therapy. “Our findings do not establish sufficient risk that azathioprine should be withheld in lupus pregnancy requiring immunosuppressive therapy, since active, untreated disease may result in worse maternal and fetal outcomes," the authors wrote.

That being said, since early identification and intervention improves long-term outcomes for kids with developmental delay, the authors recommended early developmental screening of children born to mothers with lupus.

This study was published in the May issue of Arthritis Care and Research.

The research was supported by the Herbert and Carol Amster Lupus Research Fund and the Michael and Marcia Klein Lupus Research Fund and grants from the NIH and National Center for Research Resources. The authors did not disclose any financial affiliations or conflicts of interest.

Reviewed by: 
Review Date: 
May 16, 2013
Last Updated:
September 17, 2013