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

Child/Infant infections (> 1 year)

id	Study   Auto Reynolds, 2022Kanis, 2021Meyer a (Controls exposed to Anti-TNF), 2021Meyer a (Controls unexposed, sick), 2021Norgard, 2020Angelberger, 2011	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.
S13740 R53544	Reynolds, 2022	Childhood infection - Median follow up: 3.23 years	throughout pregnancy	retrospective cohort	unexposed, sick	Adjustment: Yes Indications: Systemic lupus erythematosus (SLE)	2.43 [1.01;5.87]	21/87   27/197	48	87		ref
S12244 R46203	Kanis, 2021	Severe infection (infection for which hospital admission was necessary) in child up to 5 years old	throughout pregnancy	retrospective cohort	unexposed, sick	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	1.35 [0.85;2.15]	30/240   58/564	88	240		ref
S13540 R52321	Meyer a (Controls exposed to Anti-TNF), 2021	Serious infection between the 3rd to 5th year of life (defined as infection requiring hospitalization as the primary diagnosis)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	1.11 [0.81;1.52] excluded (control group)	-/3,392   -/3,399	-	3,392		ref
S12215 R45515	Meyer a (Controls unexposed, sick), 2021	Serious infection between the 3rd to 5th year of life (defined as infection requiring hospitalization as the primary diagnosis)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: Yes Indications: Inflammatory Bowel disease (IBD)	1.00 [0.82;1.22]	-/3,392   -/18,954	-	3,392		ref
S6294 R17982	Norgard, 2020	Infection, any kind diagnosed in a hospital (child 1-3 year)	3 months (or more) before pregnancy or during pregnancy excluded	population based cohort retrospective	unexposed (general population or NOS)	Adjustment: Yes Indications: Any or not specified	1.03 [0.88;1.21] excluded (exposition period)	151/891   158,595/1,133,242	158,746	891		ref
S13762 R53580	Angelberger, 2011	Hospitalisation due to an infection (median observation period in AZA = 3.3 years, in no AZA = 4.7 years)	during pregnancy (anytime or not specified)	retrospective cohort	unexposed, sick	Adjustment: No Indications: Inflammatory Bowel disease (IBD)	0.38 [0.07;1.92] C	3/15   6/15	9	15		ref
					Total	4 studies	1.19 [0.79;1.80]		145	3,734
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 13540