CASE REPORT: MESALAMINE USE IN PREGNANCY AND TWO BABIES WITH SITUS INVERSUS TOTALIS FROM SAME MOTHER

Gün E., Erköseoğlu İ., Duman M., Yarış E., Kalyoncu N. İ.

5th Regional TIAFT Meeting in TURKIYE, Diyarbakır, Türkiye, 9 - 11 Ekim 2024

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Diyarbakır
  • Basıldığı Ülke: Türkiye
  • Karadeniz Teknik Üniversitesi Adresli: Evet

Özet

Introduction: Mesalamine, a 5-aminosalicyclic acid derivative drug is used in the treatment of ulcerative colitis since 1940’s. It is available in capsule, rectal suspension and suppository pharmaceutical forms and thought to have a local anti-inflammatory effect. Its therapeutic effect is primarily through the inhibition of arachidonic acid synthesis. Since there is not potential teratogenic data of mesalamine, it is not discontinued during pregnancy in patients with ulcerative colitis. In humans, it has been reported that mesalamine crosses the placenta and the drug metabolites are at similar levels in maternal and fetal circulations. Animal studies have not shown any congenital malformations with mesalamine use. In case reports, prospective controlled human studies and population-based studies did not report a significant association between mesalamine use during pregnancy and an increased risk of congenital malformations. Preterm birth, stillbirth and low birth weight are seen but not related directly to mesalamine.

Case: Before the diagnosis of ulcerative colitis, our case gave a healthy baby without any medication in 2011. After her first birth, at the age of 34, she started to use mesalamine (Asacol ® 800 mg enteric tablet, 3x1) with a diagnosis of ulcerative colitis. The patient was referred to the Trabzon Teratogenicity Information Service in 2014 for evaluation of mesalamine use in pregnancy.  When she applied to our center, she was 5 weeks and 5 days pregnant (Gravida 2) and it was confirmed with USG. Case was evaluated about additional risk factors (age, smoking, alcohol use, Rh incompatibility, consanguineous marriage, concomitant drugs, etc.). Since any additional risk factor was observed, and no teratogenic effect due to mesalamine was reported clinician decided to not to discontinue the drug during whole pregnancy upon our proposal. The mother gave a term birth in 2015, and situs inversus totalis was observed in the hospital. The baby did not suffer from this clinical status, and she is still healthy. In our follow-up interviews we learned that the mother gave another term baby in 2019 while she was 39 years old, under mesalamine therapy at the dose and period of second pregnancy. Interestingly, this baby was diagnosed with situs inversus totalis; she is still healthy.

 Conclusion: There is not any family history showing possible situs inversus totalis. While mother’s first baby did not show situs inversus totalis without any medication, following two babies have situs inversus totalis. The ratio of this clinical status is 1/5000-10000 birth. It is interesting that the consecutive babies from the same mother were situs inversus totalis which is a very rare anomaly. There is no animal or human data was present in the literature that mesalamine use during pregnancy is associated with congenital malformations in the fetus.

 Keywords: mesalamine, pregnancy, situs inversus totalis