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Imuran and Pregnancy?

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Posted 1/23/2008 4:12 AM (GMT 0)
Have any of you had experience with trying for a pregnancy while on imuran? I am encouraged to hear of so many pregnant forum members, but when I do a quick scan of your meds, most of you are on asacol or enemas, not on the immunosupressants. My husband and I would like to try for a third child, if my disease can bump into a good remission, but I am very scared about the risks all of my medications could have. Any suggestions/comments are appreciated! Thanks,
Posted 1/23/2008 2:46 PM (GMT 0)
There have been a few threads about this lately. I too am considering pregnancy while on imuran. My Gi says it's ok, many others say its not. There doesn't seem to be any sort of agreement by GI's or OB's about this. Same with remicade. The FDA says that imuran is to only be used when absolutely neccessary but remicade is ok. I am planning on getting as much info as i can. then it's a personal decision. Lots of women have given birth to healthy babies on both drugs but there are no studies on long term affects (the drugs are too new). My GI said that the best thing for a pregnancy is for the mother to be healthy and that might mean imuran.

Ask your Gi what he/she thinks. Let us know! more info the better!
Posted 1/23/2008 6:41 PM (GMT 0)
I will most likely be on imuran when pregnant, as soon as my kidney's are healthy and my uc is in remission, I want to get knocked up. My GI says it is ok but I also want to meet with an OB with my husband and for it to be a joint decision we make. Search the threads with keywords 'pregancy imuran' and you will find more info.

I wish I could breastfeed but I do not think I will, I know it is not optimum to be on imuran while pg but I know that I need to be healthy and hope to limit the exposure, not sure if that is even helpful but that is what I am thinking.
Posted 1/24/2008 3:54 AM (GMT 0)
Thanks, Kelly and Beth! My pediatrician/ob/GI team had me discontinue breastfeeding when i started imuran, so the breastfeeding is probably not an option, although I think the pregnancy is still possible.

I'll do a search of the threads, I didn't know you could do that-thanks so much!
Posted 1/24/2008 5:06 AM (GMT 0)
it's not the best thing to be on any drug while pregnant, and there are risks. BUT you can counteract those risks of immuran by taking ALOT of folic acid, start taking it now, at least 4mg, that helps to counteract brain and spinal defects. I was pregnant while on immuran, and i saw a high risk OB (actually two of them) about a year before i even started thinkign about getting pregnant, it can take up to six months for immuran to ge tout of your system. Both Obs told me that while immuran is a class D drug, and there are alot of other Class D drugs, there are very few that are actually as bad as they are made out to be. The porblems it would cause to the baby if you went into a flare are far worse than the risks posed by immuran. There are some risks, sphinibda, but check the label of almost any drug, see what they say about taking it while you are pregnant. the most likely birth defect, and it is a little more prevelant, is cleft pallete, which can be easily fixed with plastic surgery and noone would even know. During my preg i was followed by those high risk obs, and also another practice that had delivered many babies born to mom's on diff meds, you will need to deliver in a level 2 or higher nursery, just in case and you will probably get more ultrasounds. My child is two and half now, he has had no problems related to that, he is so smart it is scary, he can already add, so that shows you no brain damage!
Hope that helps
Posted 1/24/2008 1:35 PM (GMT 0)

Hi!  I have not posted here is foreeeeever, but check in from time to time and this post caught my eye.

I am currently pregnant and on 100 mg of Imuran (disregard whatever my sig might say, that is old info).  It is my third pregnancy and was definitely unplanned.  I was not taking Imuran with my other pregnancies and flipped out when I found out I was pregnant.  I am currently 12.5 weeks along.

Here's what I have gathered from my OB, GI and high risk OB (which I now require b/c of the Imuran...which is a category D drug).  They all agree that Imuran does not significantly raise your chances of anything being wrong with your baby.  They have found it harmful in rats and mice (which is why it is category D), but have not found any increase in birth defects in humans.  All 3 of my doc's agree that staying on the Imuran is much better than getting off, flaring badly and possibly losing the baby (if I get very sick).

If it makes you feel better, I just had my first scan with my high risk OB.  They have a very high tech ultrasound machine and can see EVERYTHING.  The baby looked just as good as my other two!  :)

I think it is fine to get pregnant.  Good luck!

Posted 1/24/2008 2:20 PM (GMT 0)
I don't plan to have anymore children but my GI has basically told me the same thing the last poster said. It is safer to be on Imuran and not flare than to flare and risk losing the baby.

If I were planning on having more children I would definitely try to find an OB/gyn that has dealt w/ IBD patients before.
Posted 1/24/2008 2:21 PM (GMT 0)
My GI told me that I wouldn't need a high risk ob (even on imuran) unless i started to flare. Anyone told anthing different? Anyone planning on high risk anyway?
Posted 1/24/2008 3:53 PM (GMT 0)
My GI and GYN told me to go to a high-risk OB from the start... regardless of whether I was flaring. So, I have been seeing a high-risk OB since the absolute beginning of my pregnancy. I am thankful I did it that way because I already had the relationship established with him when I flared during the first trimester.

Regardless of whether you go high-risk or not, you should definitely make sure that you find an OB who is able and willing to work closely with your GI. They need to stay in regular contact with each other throughout your pregnancy. Both my OB and GI are at the Cleveland Clinic, and the Clinic now has their charts all computerized. It's great because each Dr. can just log into the computer and see information from the other Dr. in seconds. It has really been helpful during the flare and with the anemia.
Posted 1/24/2008 8:56 PM (GMT 0)
Thank you, everyone! I have my annual exam with my regular OB in March, and am going to discuss the pros and cons with her then, so if she has anything more to add or share, I will be sure to pass it along. Your success stories are so encouraging!
Posted 1/25/2008 4:21 AM (GMT 0)
usually you would want to get established with a high risk, because of possible complications, not only from the meds, but from the disease, and it can be hard to get into to see them. Also high risk obs have access to better ultrasounds (at least around here) and you can get a better pic and other things with those that you can't get from a reg OB
Posted 1/25/2008 8:24 PM (GMT 0)
I am on 50 mg imuran and I'm six weeks pregnant with my second child. Didn't have UC when I was pregnant 6 years ago (diagnosed a year after birth). My docs are all OK with me being on it, and we had no trouble conceiving (and I'm 36, so age is working against me too). Only problem is that I'm now flaring. Started right before I found out I was pregnant, then stopped. Just started again this week, and I'm waiting for a GI opinion.
Posted 3/9/2008 5:15 AM (GMT 0)
Hello,

I am so happy to finally find a forum of women with UC who are new moms and possibly trying to breastfeed. I am 37 and just had a healthy baby boy, while staying on Imuran, Asacol and Folic Acid throughout the pregnancy. My GI and OB both said those drugs were fine in pregnancy. I believe I started flaring the last month and a half of the pregnancy though with constant diahrrea (though other pregnant women can get that too at the end). I also developed cholestasis at 24 weeks to add to my higher risk status (your gallbladder doesn't work right, liver bile acids back up into your bloodstream and you itch from the inside out - lovely when you can't take NSAIDS!!.

Then we had a fairly difficult labor - lots of pushing, tried forceps and in the end a C-section. He was very healthy and has continued to grow great in the first two weeks so I wouldn't worry about Imuran during pregnancy. Anyway, I had a big flare up the second night in the hospital, it calmed down a bit and when we went home and then I started flaring again big time. I had stopped Imuran a week before the delivery and planned to stay off it while breastfeeding. Well, I ended up so delirious from losing blood, Potassium, electrolytes and being dehydrated from going to the bathroom so much (even getting up during feedings) that I wound up back in the hospital for almost three days. I was taking 175 MG of Imuran. I stayed on 3200 MG of Asacol and IMG of Folic Acid during feeding.

All the docs still encouraged me to keep up with the breastfeeding, putting me on Prednisone (all my docs said studies have shown it gets into breastmilk but is fine), and upping my Asacol another 1200 mg along with nightly enemas. But me and my family needed to make a decision about my health so I can be there for our son and not get any worse. My last bad flare I ended up with Remicade infusions and that would be a big chunk of time away from a newborn and not something I wish to repeat. Also, when I asked why I could find no women in my area of Colorado or really anywhere online who have UC and are breastfeeding, he said most women are afraid to go off their meds and flare up so decide to use formula. I was pretty determined to breastfeed, but I sure wish my docs could have helped me be more realistic about the possibility of a bad flare!!

Have other moms out there tried to go off Imuran and breastfeed?? If so, what was your experience? Did you flare? Suck it up? Try other meds?
Any responses would be greatly appreciatiated because I feel pretty alone on this.
Posted 3/9/2008 5:35 AM (GMT 0)
I always like to follow these threads, because I will likely be in the same boat in the near future.

My first pregnancy with DD was great and fairly uneventful. My UC was calm throughout except for minimal bleeding in the 3rd trimester, which I actually think was hemorrhoids. However, ever since DD was born, my UC has taken a turn for the worst and I've been struggling to get it under control for the last 18 months. I'm actually meeting with my GI on Tuesday and will likely be starting 6-MP, since I seem to flare a month or two after tapering off prednisone. I've gone round and round with my GI docs, OB, and high risk OB about taking 6-MP while pregnant. I'm not sure I'm completely convinced it's okay, but at some point I just need to put my faith and trust in someone and listen to their advice.

It's VERY helpful to hear from the rest of you who have had healthy pregnancy while being on these meds. I was hoping to get in remission from prednisone and have Colazal hold me in remission and then get pregnant. My OB seemed to think as long as I was in remission and got pregnant my UC would likely stay calm since it did for my first pregnancy, but I just can't seem to get and stay in remission right now.

My biggest question is if GI docs are okay with us staying on Imuran/6-MP while pregnant, then why can't we breastfeed on it? Someone else mentioned breastfeeding while on prednisone and I pretty much breastfed DD from when she was 6 weeks old while on 60 mgs of prednisone. I was on that high of a dose for a 2 months with her while breastfeeding and then started to taper. She did fine and I breastfed her for 9 months (she also had formula too by then).
Posted 3/9/2008 5:39 AM (GMT 0)
Oh, one other question. For those who had been on Imuran/6-MP before getting pregnant, how long had you been taking it prior to getting pregnant? Was your UC fully in remission from these drugs and then you got pregnant? I really wanted to try to get pregnant at the beginning of this year and now it seems like I need to wait until I start 6-MP and get my UC in control, which from my understanding could take at least 6 months for 6-MP to start working.
Posted 3/10/2008 5:33 AM (GMT 0)
In terms of your question about being pregnant on Imuran versus breastfeeding on it, my understanding is while it does not pass through the placenta it does pass through the breastmilk. Does that make sense? I don't have a great understanding for whether it is easier for drugs to pass through one and not the other, but I think more stuff gets into the breastmilk and directly to the baby that way.

My docs said to be on the lowest dose Imuran I could safely be on during pregnancy but not to worry about any problems with the baby. I actually went down 5 MGs on my dosage at one point because my metabolites and liver enzymes kept creeping up. I didn't have any side effects or flares from that.

I was monitored very closely from 26 weeks on anyway because I had cholestasis and my age (37). Weekly NSTs, blood tests and OB appointments and a couple additional ultrasounds. My son was a healthy 8 pounds 5 oz at 37 weeks!
Posted 3/10/2008 5:40 AM (GMT 0)
Just now saw your second question about how long I'd been on Imuran before getting pregnant. I got on Imuran at the beginning of 2006, in conjunction with Remicade infusions. Imuran has been great for me! However, it does indeed take some time to really work although depending on what else you're doing 6 months seems like a long time for it to really kick in. I worked for me before that, probably within a few weeks but again I was doing it with Remicade and also not trying to get pregnant at that time.

I am just hoping that since I've only been off it for a couple weeks, right before my baby was born, that now that I need to resume it it won't take too long to start working again. The GI docs can't really say for sure at this point.

Ideally you would want to get your UC in remission before getting pregnant. I had been in remission for many months before we started trying. (I have left-sided, moderate UC). I just think it will get you off on a better foot. My GI doc said many women feel better while pregnant, or get better after giving birth. I went downhill a bit in the last month or two and obviously flared badly a few days after giving birth so go figure! Everyone is different, I suppose.

Good luck!!
Posted 3/10/2008 1:05 PM (GMT 0)
Thanks FTC. That is helpful. Yes, I really hope if I do start 6mp that it starts working sooner than the 6 months people mention, because I would like to start ttc again soon. I know it's best for me and the fetus to be in remission which is why I think my GI suggested I really wait to see how things go. When I was pregnant with DD, at the time, my UC was just on my left side and was fairly calm before getting pregnant and was fine throughout. However, I had a bad flare postpartum and now my whole colon is infected and it's much harder to treat which is why I might have to start the 6mp. I'm just so anxious about starting a new medication, possibly stopping it, starting again, etc....I really wish I could get in remission without having to try this and get pregnant without being on anything like I was with DD, but that doesn't seem likely this time around.
Posted 3/10/2008 9:52 PM (GMT 0)
This thread is so useful! I'm currently waiting to be diagnosed, but also want to ttc. I'm 36 and recently had a mc unfortunately, though it was very early on and I think just "one of those things". Such a lot of useful information and I must say it is somewhat calming my anxious mind about the whole business. Thanks everyone xx
Posted 3/11/2008 12:11 AM (GMT 0)
love in a mist -

I also had a miscarriage before getting pregnant with WE. We had the baby's tissue tested and found that it was a chromosomal abnormality caused by old eggs (I'm 37). I guess I never worried it had anything to do with my UC or meds. So when we got pregnant again 3 months later, we had an early CVS test and were comforted that the chromosomes were all in order and that wouldn't be an issue. I really had no problems with my pregnancy, only handling things after a long and somewhat traumatic labor (induction and all the interventions possible, pushed, tried forceps and eventually a C-section). My colitis always flares after a big event in my life anyway, no matter how well I think I'm managing the stress.

My GI claimed many women even improve during pregnancy. When I stayed about the same, he said lots of gals improve after the baby is born - still hoping on that one tongue.

I noticed you are taking a more natural approach with your illness. Have you had much luck with the vitamins and acupuncture? What is Prebiotic? Lots of folks on this board mention it and I've never heard of it. I see a chiropractor and used to do regular massage which has helped a lot in the past.

Take care
Posted 3/11/2008 7:15 PM (GMT 0)
Hello FTC,

Thanks for sharing all of that, it really is so encouraging! I was seeing a naturopath last year for about 6 months (whilst I was waiting for my sigmoidoscopy which finally happened in December - that came back "inconclusive" apart from there being inflammation in the colon), who put in me on the basic Vit b, c, efa's and acidophillius (i was already on the prenatals). He also tried various supplements directly linked to the gut and whilst those I'm still taking have remained the same, changed about 4 around every month. However, it was just so expensive (£400), I have stopped seeing him but am sticking to the original basics. I work with children and for years I've caught all the winter bugs, but this past winter have had none, so I know that my immune system is alot stronger now than it has been in recent years. I attribute that to the supplements. Because I have not had a proper diagnosis yet, the naturopath was treating my gut (i have some IBS type symptoms like bloating), the bloating has totally gone now. I've also cut out alcohol and my vice was chocolate.

The acupuncture I started just 5 weeks ago (alot cheaper than all the supps!!), and whilst he's treating me as a "whole" he's also concentrating points linked to the colon and inflammation. I have noticed a bit of a shift in what's going on. My problem is bleeding and mucous, though it is not alot at the moment, and I even had 3 days last week where I had none at all, which frankly stunned me as I've been living with this problem for a few years (misdiagnosed at piles, twice).. . So I think yes, the acupuncture is slowly having an effect and for me the supplements have really strengthened me! The prebiotic is called Prebio 7 (I'm in the UK) and is "2 types of fibre and 7 types of friendly bacteria" the friendly bacteria stays in the intestine to hopefully improve things in there! Prebiotics have also been linked to improved absorption of nutrients. I really felt prior to the supps, that my body was just not absorbing any of the nutrients from my food and I was not digesting food properly. That side of things has really improved dramatically. I always favour holistic solutions where possible, though I realise with UC from what I've been reading, this isn't entirely possible.

As soon as i have been properly diagnosed and know what I'm up against, I will be just continuing to prepare for another pregnancy, hopefully a successful one next time around. It is just such a roller coaster ttc and I don't see how you can ever relax!!!! Your labour does sound very traumatic too, but good to know the little one and you were safe in the end xx
Posted 4/8/2008 7:10 PM (GMT 0)

Hi Everyone, I was happy to find these posts.  I have Crohn's Disease (diagnosed in 2001)  and am on 300mg daily of Immuran and currently 16 weeks pregnant.  I first saw a high-risk OB 6 months prior to starting to try to get pregnant.  That way my husband and I were educated on the risk, what meds to stay on and everything else.  I felt comforted seeing the high-risk OB as they were not so 'freaked' out with a Class D drug and Crohn's disease.  (we also saw a regular OB who was ver unsure about it all).

I have always hoped to be able to breastfeed but cannot take the risk of going off of the Immuran.  My GI and OB doctors tell me there is no research on breast feeding on Immuran therefore they cannot recommend it.  I urge everyone out there if you are pregnant or want to become pregant and on Immuran to get involved with studies.  My progress is currently being tracked and I hope my pregnancy will only help others with Crohn's in the future.

So far everything with my pregnancy has been okay, little flares here and there, mostly just days with dirrehea followed by an IV to get the fluids back. 

I have a question to other out there:  Since I have a history of fistulas I was told I would need to have a scheduled C-section as the risk of a fistula devolping if I tore would be too great. Has anyone else been told this? 

Also I have been warned there is an elevated risk of pre-term labor and delivery while on Immuran and with Crohns'  has anyone else heard this or expeinced this?

Thanks so much. - Amy

Posted 4/10/2008 2:33 AM (GMT 0)
powtera,

i Have UC (diagnosed in 2000)
during my first pregancy, my OB suggested that i discontinue taking imuran, and much to my GI's disapproval i did, i was in and out of the hospital for the entire nine months, with horrible flare-ups. i was put on prednisone early on in the pregnancy, and prayed for the best. I had a very healthy beautiful baby girl, but i was miserably sick, and having a tough time enjoying her. during my second pregnancy (a beautiful, unplanned surprise) i was having remicade infusions every six weeks, and decided to continue with the infusions. i had a glorious pregnancy and another healthy baby.

i dont know if there is any right answer... from here on out, everything you do will affect another life! welcome to parenting!!! just do what feels right for you, with prayer and research and then live with your choice and don't look back. try to enjoy being pregnant, its a joy that we don't get to experience for long enough. :)

my doctor also encouraged me to have a planned c-section with fear of tearing. it was great, and quick and overwith. i did it again the second time and had no trouble then either. best of luck to you, let me know if i can answer any questions.
Posted 12/18/2009 6:22 PM (GMT 0)

UCmomto2 said...

Hi!  I have not posted here is foreeeeever, but check in from time to time and this post caught my eye.

I am currently pregnant and on 100 mg of Imuran (disregard whatever my sig might say, that is old info).  It is my third pregnancy and was definitely unplanned.  I was not taking Imuran with my other pregnancies and flipped out when I found out I was pregnant.  I am currently 12.5 weeks along.

Here's what I have gathered from my OB, GI and high risk OB (which I now require b/c of the Imuran...which is a category D drug).  They all agree that Imuran does not significantly raise your chances of anything being wrong with your baby.  They have found it harmful in rats and mice (which is why it is category D), but have not found any increase in birth defects in humans.  All 3 of my doc's agree that staying on the Imuran is much better than getting off, flaring badly and possibly losing the baby (if I get very sick).

If it makes you feel better, I just had my first scan with my high risk OB.  They have a very high tech ultrasound machine and can see EVERYTHING.  The baby looked just as good as my other two!  :)

I think it is fine to get pregnant.  Good luck!

So what happened? Didi you have a healthy baby on Imuran? Iam currently pregnant on 50mg Imuran. I'm 6 weeks pregnant. I'm very scared to miscarry or have a child with birth defects..Please let me know how this turned out for you. Thanks.


Posted 12/19/2009 2:46 AM (GMT 0)
When I was pregnant I took Lialda (4x) and prednisone (20 mg) every day. My daughter, so far, is a happy 2 month old. I went on prednisone only after researching and talking with dr's and pharmacists and internet, and found it to be okay to take (that's how I found this site). My GI wanted me on Remicade, but when he got a 2nd opinion the lady said absolutely not. I switched to imuran right after delivery. I was told by many that taking the imuran at night and throwing the first morning milk away was fine and I could still bf because imuran was not found in the day milk. I did that for a few days and then quit imuran because I hated throwing the milk away, it felt like a waste. I'm now tapering off prednisone and starting to flare more. If it gets any worse, I don't know what I'll do...

Anyways, being healthy for your growing baby is very important. I was in a flare my entire pregnancy, it sucked... but on the bright side, you don't have to deal with the constipation! :) After you find out all the facts on the meds you are considering then make your decision. Good luck!
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