Do I wait? The 6 month Imuran question...

How long were you on Imuran?  I took it for a month and couldn't tolerate it.  My doc hasn't said anything about waiting to get pregnant and he knows we are actively trying (without much luck).  I wasn't aware you are supposed to wait...or is it related to how long you were on Imuran?

Sorry, I seem to have only asked you questions and didn't answer yours.  I wish I had some advice for you.  It seems like there is a lot of information out there and often I feel like we have to make decisions for ourselves rather than the doctor doing it for us.  I'm going to ask my doctor about this when I see him next week...

Tiggertenn

Thanks so much to you both - tiggertenn, I TOTALLY feel you on listening to ourselves rather than our docs sometimes. With this whole baby thing being new, I'm a little insecure about how to proceed - I'd love to know what your doc says. I did tolerate Imuran (it was actually 6-MP, but they're virtually the same thing) well for about 9 months. For the last 6-8 weeks I was only on 25 mg - a very small dose. That makes me feel a bit better about conceiving sooner than later.

Sweetie31105 keep me posted! I'd like to know there was a pregnant UC buddy out there somewhere....

Side note: are you both familiar with the book Taking Charge of Your Fertility? My doc recommended it for getting clear fertility signs.

Anyone else heard anything about the 6 month rule?

Jones

__________
31 y.o. female, left-sided UC, dx'ed 2003
Just had my last Remicade infusion, going to begin Asacol in mid-March
Multi, omega-3s, Zyflamend, Chinese herbs

I got told by my pharmacist (his sister also has UC) that after Imuran I was supposed to wait 5 years if I chose to get pregnant (which I never will ever)...*shrugs*

I'm pregnant (about 6 wks) and taking imuran, 100mg's. After extensive research (about 2 years) and various consults with high-risk OB's, decided was safest for me to stay on imuran and try for pregnancy. the risk for early miscarriage is higher while on imuran. if you don't miscarry, the baby shows absolutely no higher risks of disease or morbidity (defects, etc).

if you haven't consulted with a high-risk ob-gyn who is familiar with chrons/cholitis patients and pregnancy, you may want to contact them. general OB's really aren't familiar with these pregnancies, and often their advice doesn't reflect the latest research.

tough decision, i am right there with you! my initial conversations w/ my OB and my GI gave me completely contradictory advice; OB said come off all meds then try for preg, is much safer; GI said stay on all meds, is much safer! What's a girl to do?

This girl called her friend at Harvard who happens to be an obstetrician, who then contacted the whole high-risk department there. Harvard's program docs all said to stay on imuran, and accept that you may miscarry. Harvard's program also said that if the preg does not miscarry, I have no greater risk of fetal abnormalities than the general population.

This sentiment was echoed by docs at the Mayo clinic.

I wish you the best of luck with your decision!

I have to agree with Erica...I have met with High Risk OB's at the best hospitals in Boston and they said it is ok to take 6MP and remicade while be preggo. They said they have delivered perfectly healthy babies from mothers who have taken the drugs. In fact remicade is a category B which is as safe as you can get. Not sure if you might consider changing to remi.
ALL doctors agreed and said it was better for the baby for the flare to be under control; healthy mom = healthy baby.

Good luck with your decision. I am right there with you! I just started 6MP and I am about to do my 5th IVF cycle...prob. in May. I want to wait till I am in full remission....

Baby Dust!

I'm in agreement with Toothfairy and Wishful. I'm 34 weeks pregnant and am on 6MP while pregnant. Like you, I thought I would get in remission, go off 6MP and then try to get pregnant, but my GI, high risk OB, and OB all agreed the best thing was to keep me in remission and flare free. When I got pregnant I was feeling better than I had in 2 years and stayed that way all through the first trimester. I have been closely monitored by all doctors throughout the pregnancy and the baby appears to be growing and developing well.

Something to consider is if you do decide to go off the Imuran for 6 months or a period of time before getting pregnant and go into a flare then it will postpone when you can get pregnant. Good luck with your decision and I hope you have a happy and healthy pregnancy in the near future.

Toothfairy - That's great news about your hcg levels. How are you feeling during the first trimester? I'm not kidding when I say I felt better than I ever have in over 2 years during the beginning of my pregnancy. For once I truly felt healthy. I hope the same happens for you.

about breastfeeding. That is my biggest decision right now. I breastfed my first daughter for 9 months and it was wonderful. For the first eight weeks I was on no medication for her. Then my flare started which is what has changed my life ever since. Pretty much from 8 weeks on I was on varying doses of prednisone, as high as 60 mgs and Asacol for a period of time. After many consultations with her pediatrician and lactation specialists it was determined that she was getting very little of the medicine through the breast milk and I could continue to breastfeed if I felt up to it. I did continue, but also started supplementing with formula to give my body a little break until the flare got under control.

Now, with the 6MP it seems that everything you read online says you shouldn't breastfeed. My GI specializes in just IBD and has said that he knows of patients who decide to breastfeed while on 6MP and those who go off of it about 1 week prior to delivery. He won't tell me exactly what to do, but he has indicated that if I were to flare postpartum then it's harder to get it under control and to care for my baby. Which is exactly what happened last time and I was miserable and could not care for my daughter and actually ended up hospitalized for the first time ever having UC in over 14 years at the time. (I had a different GI last time).

I recently talked to a lactation consultant who helped me last time and she said according to Dr. Hale's (breastfeeding expert) latest edition of Medication in Mother's Milk that the mothers who were on 6MP and breastfeed showed that minimal amounts of the drug made it into the breastmilk. That the peak amount was 2 hours after taking the medication. And that the babies who were tested to see if it was actually in their blood had nothing of significance. He goes onto to say that if you've taken it all through the pregnancy that a fetus has more exposure to the drug during pregnancy than through breastmilk. That is the first time I had heard that. It had always confused me why something would be okay during pregnancy and not for breastfeeding. But as my GI and lactation specialist said, that during pregnancy sometimes you don't have any other options. You HAVE to take something to keep the mother healthy in order to carry a pregnancy to term. Whereas, since there are other options for breastfeeding, no one is going to say it's safe or okay to take certain drugs while breastfeeding. Plus, NO drug company would ever nor could ever test on pregnant or breastfeeding woman. But that's not to say there haven't been people out there who have done it. There are just no formal studies.

So to answer your question in a very long way, I am seriously considering breastfeeding while on 6MP. I still intend to talk to my pediatrician and some other lactation specialist, but from what I've found recently it doesn't appear to be as harmful as I once thought.

Erica - I know what you mean about feeling the pregnancy symptoms in the first trimester. As lousy as they make you feel it is reassuring. With my first daughter I was miserable in the first trimester. This pregnancy, nothing. Not a single symptom. It was great, because I felt so good, but I didn't believe I was pregnant until I finally saw the baby and heard the heartbeat at 7 weeks. Hopefully the symptoms will ease up for you soon.

That's good to know about your scope putting you into labor. My GI had suggested if I was still flaring of the possibility of doing an unsedated sigmoidoscopy to see how bad the rectum was inflamed to help decide if I should have c-section vs. vaginal birth. I'm hoping we don't have to do it. My flare is manageable and last time I did tear, but only a 2 and supposedly you don't tear as bad the second time. So I'm hoping to avoid the sigmoidoscopy and a c-section if possible.

I would love to know if there are others on here who breastfed while on 6MP. When you do a search, I think I've only seen one other person say they have breastfed while on 6MP/Imuran. I wish it was easier to find information on the subject instead of just one sentence on whatever site you go to saying not to do it. I would love some explanation to why or why not it's not recommended.