6MP and Pregnancy

According to several articles I have read, there is contradicting opinions on this. It is considered a category D drug. I read an article which said that it should not be taken by pregnant women unless the "benefits outweigh the risks". Then, I read another article which said that 6mp is safe for pregnant women. I had this issue when I was pregnant and taking another non UC related drug  which was a category C. I decided to take it since the benefits outweighed the risks. I did decide not to breastfeed while taking the drug, though.

Here are some links to the articles: http://www.doctorslounge.com/gastroenterology/forums/backup/topic-12274.html

http://gastroenterology.jwatch.org/cgi/content/full/2003/325/1

Best of luck-

Hi Wishful. I'm sorry to hear you struggle and face difficult decisions. I can relate because I was in your shoes not too long ago before ultimately deciding to take the leap to 6MP.

I had my worst flare 8 weeks postpartum with my first daughter. The flare probably started because of various reasons, but I struggled for two years to get it under control. During those 2 years, I was on and off high doses of prednisone, Asacol, enemas, suppositories, and hospitalized twice. Prior to having my daughter, my UC had always been maintained with very little if any medication and controlled with diet and exercise. I had NO idea UC could be so debilitating.

After about a year of struggling with the flare the idea of 6MP was presented to me by a new GI doctor I started seeing. I was scared to death of the idea and put it off primarily because I knew I wanted to get pregnant again. Finally after my second hospitalization and dealing with the nasty side effects of prednisone I threw in the towel and decided to give 6MP a chance. This was after many many consultations with my GI, other GI docs, my OB, other OBs, a perinatologist, and lots of research. They all agreed that in my case the benefit of me being healthy and flare free before getting pregnant HIGHLY outweighed the risks of being on 6MP. I decided to trust their advice and started 6MP this past May. My GI didn't want me to get pregnant until I had been off the prednisone for a few months and had a few months of blood tests back.

The first two months of being on 6MP, while tapering off of prednisone, it was very difficult to tell what was working and what drug was causing what side effect. I was tired, but couldn't tell if it was more so than normal. I just felt a little off at first (hard to describe), but couldn't really complain because it was better than a bad flare. Then all of a sudden one day (about 2 months), I felt GREAT! I mean AWESOME. I was having one formed BM a day and couldn't remember the last time in my life what that was like. It hit me like a ton of bricks that this is what most people without UC must feel like. My energy got better and I just felt like a normal healthy person. This was back in July and my DH and I accidentally got pregnant. We were planning on trying, but not for a few more months until I got the go ahead from my GI.

When I told my GI, he was happy since I was doing so well and was flare free and my bloodwork numbers had been looking good. I went back to my OB and perinatologist and have been seeing all doctors on a regular basis during the pregnancy. The first trimester I continued to feel great. Not a single blip or problem. Didn't even realize I was pregnant. Of course I was nervous about being on the medication, but it was hard to argue with feeling so great and I saw the baby during an ultrasound at 7 weeks.

My second trimester has been a little bit different. Pregnancy wise, I feel great and no issues or discomfort. However, my UC started flaring back in October. I am convinced it was brought on my the stress of my job (work in the financial industry). Since then, I have had some bleeding, mucus, and a little diarrhea, but still some formed stools. I finally saw my GI doctor again and we are hoping a month of Colocort enemas will help get the flare under control.

Anyway, sorry for the long winded answer, but your situation sounds so similar. I got to the point where I was ready to try anything. I remember coming home from being in the hospital for the second time knowing I was going to see my GI and go on 6MP and just crying for a week. I felt so beaten down and had lost hope, but over time it's possible to get your hope and life back. Hang in there and good luck.

Oh, I'm sure someone else can answer the Imuran question better, but I believe both 6MP and Imuran are almost the same, but one (can't remember which) is already broken down a little more.

I was on 6 MP prior to becoming pregnant, and my GI doctor happened to be at a conference where an expert spoke of this exact topic. I apologize for not knowing names and facts, but my doctor spoke to the speaker after the session because she knew I was interested in getting pregnant. The gist of the conversation was 6MP was fine in his/her opinion in small doses and the other uses for 6 MP and high doses given for those reasons, non UC, were the primary basis behind it being class D. Again, sorry for the vagueness, but the outcome was low doeses (50 mg and below) is not considered enough to be impactful. I ended up being on 25 mg a day my first trimester (as well as prednisone on and off) and Asacol. I finally quit taking the 6 MP around month 4 because I flared again and my dr. and I never saw any benefit of 6 MP helping me, so why take it in the first place.

I'm 30 weeks now and just got over my second flare - back on prednisone :( . I mentioned in another thread that I started that my GI doctor is suggesting a scheduled C Section - a lot of people incorporated their feedback into that thread too if haven't seen that yet. I think it's titled UC and Pregnancy.

Good luck!

LWW1993 - thank you!! so you are currently taking 6-MP and you are pregnant? how bad of a flare were you when you went on the 6Mp and how long did it take to work?

Wishful - Yes, I am currently on 6MP and will be 29 weeks pregnant tomorrow. I take 50 mgs one night and 75 mgs the next night. I started taking 6MP back in March of 2008 (I believe, I would have to check my calendar). I conceived in July of 2008. I was on 6MP prior to getting pregnant and have been on it the entire pregnancy.

When I started taking 6MP I was in a very bad flare and just was released from the hospital for the second time in less than a year and half. Since September of 2006, after the birth of my first daughter, I was 6-8 weeks postpartum and started flaring. Ever since then I have been struggling off and on to get the flare under control. I was hospitalized twice (prior to this I had NEVER been hopsitalized or so much incapacitated from my UC during the 13 years I had lived with UC) and finally my GI and decided that prednisone was not helping me and I was becoming dependent on it. It took a few months for the 6MP to start working for me which is why you generally take prednisone at the same time. So I was slowly tapering off prednisone while slowly increasing the 6MP to the right dose for me. By June/July of 2008 I was feeling better than I had in two years, and I have to believe it was largely due to the 6MP. Coincidentally, I also got pregnant and still continued to feel great (both pregnancy and UC wise) all through my first trimester. Unfortunately, starting in October I have been flaring. I'm not 100% sure what triggered my flare (hormones, food, etc...) but I strongly believe it had to do with the stress I was experiencing at work when the financial markets started to tank.

Good luck with your decision if you decide to go on 6MP. I think I resisted the drug longer than I should as it really scared me to take it. But after the second hospitalization, I felt so hopeless, defeated, and decided I needed to give it a try to see if it would help me get my life back. I also had to put my faith and trust in all the experts, doctors, I consulted before starting the drug and getting pregnant.

Let us know how you appt with the high risk OB goes next week.

Thank you again for all your replies....
Interesting tid bit of information. I was put on sulfasalzine fromt this new GI..what my original post said. I had a terrible reaction to it. ...on the verge of going on 6MP...

I got off the hydrocortisone enemas and replaced it with rowasa enema and back to my 12 asacol pills...and I have not had any bleeding since Saturday morning!!! Its a MIRACLE!! I am thinking I must of built up an immune to the steriods and the canasa suppository wasn't reaching the proctitis. I am in remission for the first time since fathers day 08. Fingers crossed of course.

I saw a high risk OB yesterday at Beth Israel and she basically said she would like to see me in remission for 3 months before doing another round of IVF. She said if I can continue to not have any blood...they keep on these meds. She did say if I had to go on 6MP that she has delivered many healthy babies and have many pregnant mothers on 6MP. she did say I would be closely monitored and would prob would want a c-section.

I was no offended at all. Even the High Risk OB said to get in remission before trying to conceive. I asked her what if I wasn't doing IVF...she said I would tell you to use protection. The GI at Beth Israel said the same thing.

Unfortunately (today is day 7)...I saw traces of blood.....

I am BEYOND SAD. Looks like 6MP for me.

Well if it makes any of you ladies feel better I was in remission, got pregnant, had a flare that continued throughout both pregnancies. One not controlled with medication, one controlled with medication and both of my babies went to full term, one delivered vaginaly, one delivered c-section, both 9 1.2 lbs, full bill of health. If I was in a full-on nasty flare I probably would avoid trying to conceive but in my opinion, a small amount of symptoms or a mild flare wouldn't stop me. Neither of my kiddos were breastfed, the first for personal problems and the 2nd for medical, I just wasn't comfortable being on Pred. and BFing.