Thiopurines (Azathioprine, Mercaptopurin) updated on 07-28-2025

Caesarean

id	Study   Auto Vestergaard, 2024Yeaman (Controls mainly exposed to biologics), 2023Yeaman (Controls unexposed, disease free), 2023Reynolds, 2022Kanis, 2021Mahadevan, 2021Meyer b (Controls exposed to Anti-TNF), 2021Meyer b (Controls unexposed, sick), 2021Shim, 2011Goldstein, 2007	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S18482 R78415	Vestergaard, 2024	Caesarian section (all reasons)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed, sick	Adjustment: No Indications: Inflammatory Bowel disease (IBD)	1.45 [0.93;2.26] C	42/111   110/372	152	111		ref
S18477 R78397	Yeaman (Controls mainly exposed to biologics), 2023	Cesarean section	during pregnancy (anytime or not specified)	prospective cohort	exposed to other treatment, sick excluded	Adjustment: No Indications: Inflammatory Bowel disease (IBD)	1.61 [0.56;4.69] C excluded (control group)	11/19   23/50	34	19		ref
S18487 R78406	Yeaman (Controls unexposed, disease free), 2023	Cesarean section	during pregnancy (anytime or not specified)	prospective cohort	unexposed, disease free	Adjustment: No Indications: Inflammatory Bowel disease (IBD)	1.80 [0.59;5.53] C	11/19   16/37	27	19		ref
S13740 R53543	Reynolds, 2022	Caesarean section	throughout pregnancy	retrospective cohort	unexposed, sick	Adjustment: No Indications: Systemic lupus erythematosus (SLE)	0.93 [0.55;1.57] C	33/87   78/197	111	87		ref
S12244 R46196	Kanis, 2021	Caesarean section	throughout pregnancy	retrospective cohort	unexposed, sick	Adjustment: No Indications: Inflammatory Bowel disease (IBD)	1.35 [0.97;1.88] C	75/240   142/564	217	240		ref
S12218 R53495	Mahadevan, 2021	Cesarean Section	3 months (or more) before pregnancy or during pregnancy excluded	prospective cohort	unexposed, sick	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	1.30 [0.90;19.00] excluded (exposition period)	-/242   -/379	-	242		ref
S13576 R52620	Meyer b (Controls exposed to Anti-TNF), 2021	Caesarean section	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	0.76 [0.66;0.88] excluded (control group)	993/3,554   1,211/3,525	2,204	3,554		ref
S13454 R51833	Meyer b (Controls unexposed, sick), 2021	Caesarean section	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	1.18 [1.08;1.30]	993/3,554   4,650/19,811	5,643	3,554		ref
S8433 R53480	Shim, 2011	Cesarian section	throughout pregnancy	retrospective cohort	unexposed, sick	Adjustment: No Indications: Inflammatory Bowel disease (IBD) Matched	0.39 [0.12;1.29] C	4/19   30/74	34	19		ref
S8427 R46222	Goldstein, 2007	Cesarean section	at least 1st trimester excluded	prospective cohort	unexposed (general population or NOS)	Adjustment: No Indications: Any or not specified	1.70 [1.13;2.50] excluded (exposition period)	44/160   33/189	77	160		ref
					Total	6 studies	1.20 [1.03;1.40]		6,184	4,030
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 13576, 18477