1
|
Prentice R, Flanagan E, Wright E, Hardikar W, Ross A, Burns M, Prideaux L, Connell W, Sparrow M, De Cruz P, Lust M, Goldberg R, Vogrin S, Greeve T, Bell S. Thrombocytosis and Transaminitis in Infants Born to Women With Inflammatory Bowel Disease Is Associated With Exposure to Maternal Inflammation In Utero. Inflamm Bowel Dis 2024:izae008. [PMID: 38330216 DOI: 10.1093/ibd/izae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Despite reassuring clinical safety data, thrombocytosis, anemia, lymphopenia, and liver function derangements have been observed in infants born to women with inflammatory bowel disease (IBD) treated with thiopurines and biologics. We aimed to define the prevalence, course, associations, and clinical impact of hematological and biochemical abnormalities in such infants. METHODS This multicenter prospective cohort study assessed clinical, hematologic, and biochemical outcomes of infants exposed to thiopurines or biologics in utero for management of maternal IBD. Liver transaminases, full blood examination, and infant thiopurine metabolites (where exposed) were taken at delivery and 6 weeks of age. Abnormal results were repeated until normalization. Infants were followed clinically by a pediatric gastroenterologist up to 2 years of age. RESULTS A total of 130 infants were included. Thrombocytosis and elevated alanine transaminase (ALT) were seen in over half of infants up to 6 months of age with no significant clinical impact. Elevated ALT was associated with increasing maternal C-reactive protein in second trimester, while thrombocytosis was associated with increasing maternal C-reactive protein and fecal calprotectin in third trimester. Preceding infection and vaccination were associated with an increased risk of elevated alkaline phosphatase at 3 months. In those exposed to thiopurines, increasing maternal 6-methylmercaptopurine at delivery was associated with increased ALT to 6 months. CONCLUSIONS Infants born to women with IBD commonly developed thrombocytosis, elevated alkaline phosphatase, and elevated ALT. These findings were associated with exposure to maternal inflammation, elevated 6-methylmercaptopurine at delivery, and infant vaccinations and infections, and had minimal clinical consequence.
Collapse
Affiliation(s)
- Ralley Prentice
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Emma Flanagan
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Wright
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Winita Hardikar
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Gastroenterology Department, Royal Children's Hospital, Melbourne, Australia
| | - Alyson Ross
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Megan Burns
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - Lani Prideaux
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - William Connell
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Miles Sparrow
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Peter De Cruz
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Austin Health, Melbourne, Australia
| | - Mark Lust
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Rimma Goldberg
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sara Vogrin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Tessa Greeve
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - Sally Bell
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|