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Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity.

Hoeltzenbein M, Stieler K, Panse M, Wacker E, Schaefer C - PLoS ONE (2013)

Bottom Line: Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children.However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis.Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

View Article: PubMed Central - PubMed

Affiliation: Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT
Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7%) and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3-40) were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

No MeSH data available.


Related in: MedlinePlus

Estimation of cumulative incidences using survival analysis technique.Probability of spontaneous abortion was 11% (95%-confidence interval (CI) 3–40), ETOP 9% (95%-CI 2–32), and live birth 80% (95%-CI 60–85).
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pone-0066637-g003: Estimation of cumulative incidences using survival analysis technique.Probability of spontaneous abortion was 11% (95%-confidence interval (CI) 3–40), ETOP 9% (95%-CI 2–32), and live birth 80% (95%-CI 60–85).

Mentions: Cumulative incidences were 11% (95%-CI 3–40) for spontaneous abortions and 9% (95%-CI 2–32) for ETOPs (Fig. 3).


Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity.

Hoeltzenbein M, Stieler K, Panse M, Wacker E, Schaefer C - PLoS ONE (2013)

Estimation of cumulative incidences using survival analysis technique.Probability of spontaneous abortion was 11% (95%-confidence interval (CI) 3–40), ETOP 9% (95%-CI 2–32), and live birth 80% (95%-CI 60–85).
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3686712&req=5

pone-0066637-g003: Estimation of cumulative incidences using survival analysis technique.Probability of spontaneous abortion was 11% (95%-confidence interval (CI) 3–40), ETOP 9% (95%-CI 2–32), and live birth 80% (95%-CI 60–85).
Mentions: Cumulative incidences were 11% (95%-CI 3–40) for spontaneous abortions and 9% (95%-CI 2–32) for ETOPs (Fig. 3).

Bottom Line: Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children.However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis.Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

View Article: PubMed Central - PubMed

Affiliation: Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT
Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7%) and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3-40) were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

No MeSH data available.


Related in: MedlinePlus