Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates
Summary Background Azathioprine and mercaptopurine are considered safe during pregnancy. However, the pharmacokinetic effects of pregnancy on thiopurine metabolism are undefined. Aims To characterise thiopurine metabolism in pregnancy and measure infant metabolite levels and outcomes. Methods Women...
Gespeichert in:
| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2021-04, Vol.53 (7), p.810-820 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 820 |
|---|---|
| container_issue | 7 |
| container_start_page | 810 |
| container_title | Alimentary pharmacology & therapeutics |
| container_volume | 53 |
| creator | Flanagan, Emma Wright, Emily K. Hardikar, Winita Sparrow, Miles P. Connell, William R. Kamm, Michael A. De Cruz, Peter Brown, Steven J. Thompson, Alexander Greenway, Anthea Westley, Ian Barclay, Murray Ross, Alyson L. Kiburg, Katerina V. Bell, Sally J. |
| description | Summary
Background
Azathioprine and mercaptopurine are considered safe during pregnancy. However, the pharmacokinetic effects of pregnancy on thiopurine metabolism are undefined.
Aims
To characterise thiopurine metabolism in pregnancy and measure infant metabolite levels and outcomes.
Methods
Women with IBD who were taking a thiopurine and pregnant or trying to conceive were recruited. Maternal thiopurine metabolites were measured pre‐conception, in each trimester, at delivery and post‐partum. Infant metabolite levels, full blood examination and liver function testing were performed at birth, and repeated until levels undetectable and haematological and biochemical abnormalities resolved.
Results
Forty patients were included with measurements on at least two occasions, and two with only mother‐baby levels at delivery. The median maternal 6‐TGN level dropped in the second trimester compared with post‐partum (179.0 vs 323.5 pmol/8 × 108 RBCs, P |
| doi_str_mv | 10.1111/apt.16294 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2500140049</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2500140049</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4544-66cbd63223ec1669fa4b7f8cd57024acfb0113a8b96713aa7b9099a2527a0b8e3</originalsourceid><addsrcrecordid>eNp1kU1r3DAQhkVI6W7SHvIHgiCnHrzRl2XrGEKbFLa0h_RsRvI4cbAtR7LZ7B_J7632oz2lQjDM8PAgzUvIBWcrns41jNOKa2HUCVlyqfNMMKlPyZIJbTJRcrkgZzE-M8Z0wcRHspBSs7I0aknefsCEYYCOTk-tH-fQDkh7nMD6ro09rXeTRzoGfBxgcFvaDuk2HfQ9TD5sqfUb7GjdRoSIFIaaug4hJBapb96zThj3nJ8n5_vUJCW-jj5iTQf0Q3pQ_EQ-NNBF_Hys5-T3t68Pt_fZ-ufd99ubdeZUrlSmtbO1lkJIdFxr04CyRVO6Ok__VOAayziXUFqji1ShsIYZAyIXBTBbojwnVwfvGPzLjHGqnv28W0esRM4YV4wpk6gvB8oFH2PAphpD20PYVpxVuwSqlEC1TyCxl0fjbHus_5F_V56A6wOwaTvc_t9U3fx6OCj_AKzSk5o</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2500140049</pqid></control><display><type>article</type><title>Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Access via Wiley Online Library</source><source>Wiley Online Library (Open Access Collection)</source><creator>Flanagan, Emma ; Wright, Emily K. ; Hardikar, Winita ; Sparrow, Miles P. ; Connell, William R. ; Kamm, Michael A. ; De Cruz, Peter ; Brown, Steven J. ; Thompson, Alexander ; Greenway, Anthea ; Westley, Ian ; Barclay, Murray ; Ross, Alyson L. ; Kiburg, Katerina V. ; Bell, Sally J.</creator><creatorcontrib>Flanagan, Emma ; Wright, Emily K. ; Hardikar, Winita ; Sparrow, Miles P. ; Connell, William R. ; Kamm, Michael A. ; De Cruz, Peter ; Brown, Steven J. ; Thompson, Alexander ; Greenway, Anthea ; Westley, Ian ; Barclay, Murray ; Ross, Alyson L. ; Kiburg, Katerina V. ; Bell, Sally J. ; PICCOLO Study Group ; PICCOLO Study Group</creatorcontrib><description>Summary
Background
Azathioprine and mercaptopurine are considered safe during pregnancy. However, the pharmacokinetic effects of pregnancy on thiopurine metabolism are undefined.
Aims
To characterise thiopurine metabolism in pregnancy and measure infant metabolite levels and outcomes.
Methods
Women with IBD who were taking a thiopurine and pregnant or trying to conceive were recruited. Maternal thiopurine metabolites were measured pre‐conception, in each trimester, at delivery and post‐partum. Infant metabolite levels, full blood examination and liver function testing were performed at birth, and repeated until levels undetectable and haematological and biochemical abnormalities resolved.
Results
Forty patients were included with measurements on at least two occasions, and two with only mother‐baby levels at delivery. The median maternal 6‐TGN level dropped in the second trimester compared with post‐partum (179.0 vs 323.5 pmol/8 × 108 RBCs, P < 0.001) and the median 6‐MMP level increased in the second trimester compared with post‐partum (1103.0 vs 329.5 pmol/8 × 108 RBCs, P < 0.01). At delivery, the median 6‐TGN level was lower in infants (n = 20) than mothers (78.5 vs 217 pmol/8 × 108 RBCs) (P < 0.001). Metabolites were not detected at 6 weeks in any infants. Anaemia was not seen, but thrombocytosis and abnormal liver biochemistry were detected in 80% of infants from 6 weeks, which gradually improved.
Conclusions
6‐TGN levels decrease and 6‐MMP levels increase in the second trimester of pregnancy. Infants are exposed to thiopurine metabolites at low levels with clearance by 6 weeks and no anaemia. The cause of infant thrombocytosis and abnormal liver biochemistry in the absence of metabolites is unclear.
Shunting of maternal thiopurine metabolites in pregnancy
Infants exposed to metabolites with no neonatal anemia</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.16294</identifier><identifier>PMID: 33608894</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>6-Mercaptopurine ; Anemia ; Azathioprine ; Azathioprine - therapeutic use ; Babies ; Biochemistry ; Colitis ; Female ; Humans ; Immunosuppressive Agents - therapeutic use ; Infant ; Infant, Newborn ; Infants ; Inflammatory bowel diseases ; Inflammatory Bowel Diseases - drug therapy ; Intestine ; Liver ; Mercaptopurine - therapeutic use ; Metabolism ; Metabolites ; Neonates ; Pharmacokinetics ; Pregnancy ; Thionucleotides ; Thrombocytosis</subject><ispartof>Alimentary pharmacology & therapeutics, 2021-04, Vol.53 (7), p.810-820</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4544-66cbd63223ec1669fa4b7f8cd57024acfb0113a8b96713aa7b9099a2527a0b8e3</citedby><cites>FETCH-LOGICAL-c4544-66cbd63223ec1669fa4b7f8cd57024acfb0113a8b96713aa7b9099a2527a0b8e3</cites><orcidid>0000-0003-2944-8338 ; 0000-0003-2527-8044 ; 0000-0003-3319-7199 ; 0000-0002-3911-4780</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.16294$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.16294$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33608894$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Flanagan, Emma</creatorcontrib><creatorcontrib>Wright, Emily K.</creatorcontrib><creatorcontrib>Hardikar, Winita</creatorcontrib><creatorcontrib>Sparrow, Miles P.</creatorcontrib><creatorcontrib>Connell, William R.</creatorcontrib><creatorcontrib>Kamm, Michael A.</creatorcontrib><creatorcontrib>De Cruz, Peter</creatorcontrib><creatorcontrib>Brown, Steven J.</creatorcontrib><creatorcontrib>Thompson, Alexander</creatorcontrib><creatorcontrib>Greenway, Anthea</creatorcontrib><creatorcontrib>Westley, Ian</creatorcontrib><creatorcontrib>Barclay, Murray</creatorcontrib><creatorcontrib>Ross, Alyson L.</creatorcontrib><creatorcontrib>Kiburg, Katerina V.</creatorcontrib><creatorcontrib>Bell, Sally J.</creatorcontrib><creatorcontrib>PICCOLO Study Group</creatorcontrib><creatorcontrib>PICCOLO Study Group</creatorcontrib><title>Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Azathioprine and mercaptopurine are considered safe during pregnancy. However, the pharmacokinetic effects of pregnancy on thiopurine metabolism are undefined.
Aims
To characterise thiopurine metabolism in pregnancy and measure infant metabolite levels and outcomes.
Methods
Women with IBD who were taking a thiopurine and pregnant or trying to conceive were recruited. Maternal thiopurine metabolites were measured pre‐conception, in each trimester, at delivery and post‐partum. Infant metabolite levels, full blood examination and liver function testing were performed at birth, and repeated until levels undetectable and haematological and biochemical abnormalities resolved.
Results
Forty patients were included with measurements on at least two occasions, and two with only mother‐baby levels at delivery. The median maternal 6‐TGN level dropped in the second trimester compared with post‐partum (179.0 vs 323.5 pmol/8 × 108 RBCs, P < 0.001) and the median 6‐MMP level increased in the second trimester compared with post‐partum (1103.0 vs 329.5 pmol/8 × 108 RBCs, P < 0.01). At delivery, the median 6‐TGN level was lower in infants (n = 20) than mothers (78.5 vs 217 pmol/8 × 108 RBCs) (P < 0.001). Metabolites were not detected at 6 weeks in any infants. Anaemia was not seen, but thrombocytosis and abnormal liver biochemistry were detected in 80% of infants from 6 weeks, which gradually improved.
Conclusions
6‐TGN levels decrease and 6‐MMP levels increase in the second trimester of pregnancy. Infants are exposed to thiopurine metabolites at low levels with clearance by 6 weeks and no anaemia. The cause of infant thrombocytosis and abnormal liver biochemistry in the absence of metabolites is unclear.
Shunting of maternal thiopurine metabolites in pregnancy
Infants exposed to metabolites with no neonatal anemia</description><subject>6-Mercaptopurine</subject><subject>Anemia</subject><subject>Azathioprine</subject><subject>Azathioprine - therapeutic use</subject><subject>Babies</subject><subject>Biochemistry</subject><subject>Colitis</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Inflammatory bowel diseases</subject><subject>Inflammatory Bowel Diseases - drug therapy</subject><subject>Intestine</subject><subject>Liver</subject><subject>Mercaptopurine - therapeutic use</subject><subject>Metabolism</subject><subject>Metabolites</subject><subject>Neonates</subject><subject>Pharmacokinetics</subject><subject>Pregnancy</subject><subject>Thionucleotides</subject><subject>Thrombocytosis</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1r3DAQhkVI6W7SHvIHgiCnHrzRl2XrGEKbFLa0h_RsRvI4cbAtR7LZ7B_J7632oz2lQjDM8PAgzUvIBWcrns41jNOKa2HUCVlyqfNMMKlPyZIJbTJRcrkgZzE-M8Z0wcRHspBSs7I0aknefsCEYYCOTk-tH-fQDkh7nMD6ro09rXeTRzoGfBxgcFvaDuk2HfQ9TD5sqfUb7GjdRoSIFIaaug4hJBapb96zThj3nJ8n5_vUJCW-jj5iTQf0Q3pQ_EQ-NNBF_Hys5-T3t68Pt_fZ-ufd99ubdeZUrlSmtbO1lkJIdFxr04CyRVO6Ok__VOAayziXUFqji1ShsIYZAyIXBTBbojwnVwfvGPzLjHGqnv28W0esRM4YV4wpk6gvB8oFH2PAphpD20PYVpxVuwSqlEC1TyCxl0fjbHus_5F_V56A6wOwaTvc_t9U3fx6OCj_AKzSk5o</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Flanagan, Emma</creator><creator>Wright, Emily K.</creator><creator>Hardikar, Winita</creator><creator>Sparrow, Miles P.</creator><creator>Connell, William R.</creator><creator>Kamm, Michael A.</creator><creator>De Cruz, Peter</creator><creator>Brown, Steven J.</creator><creator>Thompson, Alexander</creator><creator>Greenway, Anthea</creator><creator>Westley, Ian</creator><creator>Barclay, Murray</creator><creator>Ross, Alyson L.</creator><creator>Kiburg, Katerina V.</creator><creator>Bell, Sally J.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><orcidid>https://orcid.org/0000-0003-2944-8338</orcidid><orcidid>https://orcid.org/0000-0003-2527-8044</orcidid><orcidid>https://orcid.org/0000-0003-3319-7199</orcidid><orcidid>https://orcid.org/0000-0002-3911-4780</orcidid></search><sort><creationdate>202104</creationdate><title>Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates</title><author>Flanagan, Emma ; Wright, Emily K. ; Hardikar, Winita ; Sparrow, Miles P. ; Connell, William R. ; Kamm, Michael A. ; De Cruz, Peter ; Brown, Steven J. ; Thompson, Alexander ; Greenway, Anthea ; Westley, Ian ; Barclay, Murray ; Ross, Alyson L. ; Kiburg, Katerina V. ; Bell, Sally J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4544-66cbd63223ec1669fa4b7f8cd57024acfb0113a8b96713aa7b9099a2527a0b8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>6-Mercaptopurine</topic><topic>Anemia</topic><topic>Azathioprine</topic><topic>Azathioprine - therapeutic use</topic><topic>Babies</topic><topic>Biochemistry</topic><topic>Colitis</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infants</topic><topic>Inflammatory bowel diseases</topic><topic>Inflammatory Bowel Diseases - drug therapy</topic><topic>Intestine</topic><topic>Liver</topic><topic>Mercaptopurine - therapeutic use</topic><topic>Metabolism</topic><topic>Metabolites</topic><topic>Neonates</topic><topic>Pharmacokinetics</topic><topic>Pregnancy</topic><topic>Thionucleotides</topic><topic>Thrombocytosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Flanagan, Emma</creatorcontrib><creatorcontrib>Wright, Emily K.</creatorcontrib><creatorcontrib>Hardikar, Winita</creatorcontrib><creatorcontrib>Sparrow, Miles P.</creatorcontrib><creatorcontrib>Connell, William R.</creatorcontrib><creatorcontrib>Kamm, Michael A.</creatorcontrib><creatorcontrib>De Cruz, Peter</creatorcontrib><creatorcontrib>Brown, Steven J.</creatorcontrib><creatorcontrib>Thompson, Alexander</creatorcontrib><creatorcontrib>Greenway, Anthea</creatorcontrib><creatorcontrib>Westley, Ian</creatorcontrib><creatorcontrib>Barclay, Murray</creatorcontrib><creatorcontrib>Ross, Alyson L.</creatorcontrib><creatorcontrib>Kiburg, Katerina V.</creatorcontrib><creatorcontrib>Bell, Sally J.</creatorcontrib><creatorcontrib>PICCOLO Study Group</creatorcontrib><creatorcontrib>PICCOLO Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Flanagan, Emma</au><au>Wright, Emily K.</au><au>Hardikar, Winita</au><au>Sparrow, Miles P.</au><au>Connell, William R.</au><au>Kamm, Michael A.</au><au>De Cruz, Peter</au><au>Brown, Steven J.</au><au>Thompson, Alexander</au><au>Greenway, Anthea</au><au>Westley, Ian</au><au>Barclay, Murray</au><au>Ross, Alyson L.</au><au>Kiburg, Katerina V.</au><au>Bell, Sally J.</au><aucorp>PICCOLO Study Group</aucorp><aucorp>PICCOLO Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2021-04</date><risdate>2021</risdate><volume>53</volume><issue>7</issue><spage>810</spage><epage>820</epage><pages>810-820</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Azathioprine and mercaptopurine are considered safe during pregnancy. However, the pharmacokinetic effects of pregnancy on thiopurine metabolism are undefined.
Aims
To characterise thiopurine metabolism in pregnancy and measure infant metabolite levels and outcomes.
Methods
Women with IBD who were taking a thiopurine and pregnant or trying to conceive were recruited. Maternal thiopurine metabolites were measured pre‐conception, in each trimester, at delivery and post‐partum. Infant metabolite levels, full blood examination and liver function testing were performed at birth, and repeated until levels undetectable and haematological and biochemical abnormalities resolved.
Results
Forty patients were included with measurements on at least two occasions, and two with only mother‐baby levels at delivery. The median maternal 6‐TGN level dropped in the second trimester compared with post‐partum (179.0 vs 323.5 pmol/8 × 108 RBCs, P < 0.001) and the median 6‐MMP level increased in the second trimester compared with post‐partum (1103.0 vs 329.5 pmol/8 × 108 RBCs, P < 0.01). At delivery, the median 6‐TGN level was lower in infants (n = 20) than mothers (78.5 vs 217 pmol/8 × 108 RBCs) (P < 0.001). Metabolites were not detected at 6 weeks in any infants. Anaemia was not seen, but thrombocytosis and abnormal liver biochemistry were detected in 80% of infants from 6 weeks, which gradually improved.
Conclusions
6‐TGN levels decrease and 6‐MMP levels increase in the second trimester of pregnancy. Infants are exposed to thiopurine metabolites at low levels with clearance by 6 weeks and no anaemia. The cause of infant thrombocytosis and abnormal liver biochemistry in the absence of metabolites is unclear.
Shunting of maternal thiopurine metabolites in pregnancy
Infants exposed to metabolites with no neonatal anemia</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33608894</pmid><doi>10.1111/apt.16294</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2944-8338</orcidid><orcidid>https://orcid.org/0000-0003-2527-8044</orcidid><orcidid>https://orcid.org/0000-0003-3319-7199</orcidid><orcidid>https://orcid.org/0000-0002-3911-4780</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-2813 |
| ispartof | Alimentary pharmacology & therapeutics, 2021-04, Vol.53 (7), p.810-820 |
| issn | 0269-2813 1365-2036 |
| language | eng |
| recordid | cdi_proquest_journals_2500140049 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via Wiley Online Library; Wiley Online Library (Open Access Collection) |
| subjects | 6-Mercaptopurine Anemia Azathioprine Azathioprine - therapeutic use Babies Biochemistry Colitis Female Humans Immunosuppressive Agents - therapeutic use Infant Infant, Newborn Infants Inflammatory bowel diseases Inflammatory Bowel Diseases - drug therapy Intestine Liver Mercaptopurine - therapeutic use Metabolism Metabolites Neonates Pharmacokinetics Pregnancy Thionucleotides Thrombocytosis |
| title | Maternal thiopurine metabolism during pregnancy in inflammatory bowel disease and clearance of thiopurine metabolites and outcomes in exposed neonates |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T20%3A06%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Maternal%20thiopurine%20metabolism%20during%20pregnancy%20in%20inflammatory%20bowel%20disease%20and%20clearance%20of%20thiopurine%20metabolites%20and%20outcomes%20in%20exposed%20neonates&rft.jtitle=Alimentary%20pharmacology%20&%20therapeutics&rft.au=Flanagan,%20Emma&rft.aucorp=PICCOLO%20Study%20Group&rft.date=2021-04&rft.volume=53&rft.issue=7&rft.spage=810&rft.epage=820&rft.pages=810-820&rft.issn=0269-2813&rft.eissn=1365-2036&rft_id=info:doi/10.1111/apt.16294&rft_dat=%3Cproquest_cross%3E2500140049%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2500140049&rft_id=info:pmid/33608894&rfr_iscdi=true |