In utero exposure to Azathioprine in autoimmune disease. Where do we stand?

Azathioprine (AZA), an oral immunosuppressant, is safe during pregnancy. Some reports suggested different impairments in the offspring of mothers with autoimmune diseases (AI) exposed in utero to AZA. These observations are available from retrospective studies or case reports. However, data with respect to the long-term safety in the antenatally exposed child are still lacking. The aim of this study is to summarize the current knowledge in this field and to focus on the need for a prospective study on this population. We performed a PubMed search using several search terms. The actual data show that although the risk of congenital anomalies in offspring, as well as the infertility risk, are similar to those found in general population, there is a higher incidence of prematurity, of lower weight at birth and an intra-uterine delay of development. There is also an increased risk of materno- fetal infections, especially cytomegalovirus infection. Some authors raise the interrogations about neurocognitive impairment. Even though the adverse outcomes might well be a consequence of maternal illness and disease activity, interest has been raised about a contribution of this drug. However, the interferences between the external agent (in utero exposure to AZA), with the host (child genetic susceptibility, immune system anomalies, emotional status), environment (public health, social context, availability of health care), economic, social, and behavioral conditions, cultural patterns, are complex and represent confounding factors. In conclusion, it is necessary to perform studies on the medium and long-term outcome of children born by mothers with autoimmune diseases, treated with AZA, in order to show the safety of AZA exposure. Only large-scale population studies with long-term follow-up will allow to formally conclude in this field. TAKE HOME MESSAGES.

Da prática (privada) da perversão / The (private) practice of perversion / De l'usage (privé) de la perversion / Sobre la práctica (privada) de la perversión

Elas têm vinte, trinta, quarenta ou setenta anos, e possuem a particularidade de terem conservado um objeto transicional, um "doudou", pequeno pedaço de tecido ou pelúcia surrada remontando à primeira infância, que lhes proporcionam uma sensação "única", convocando um sentimento de quietude e de alegria, dos quais elas não podem - nem querem - se abster. Essa persistência do "objeto transicional" abre uma dupla interrogação sobre, de um lado, a natureza e o estatuto desse objeto e, de outro lado, a existência de um fetichismo específico, próprio ao sexo feminino, convocando, desse modo, um erotismo singular.

They are 20, 30, 40 or even 70 year-old women and they all have the distinctive feature of having held on to a transitional object, such as a blanket, some piece of cloth or a worn-out cuddly toy that dates back to their early childhood. This object provides them with a "unique" sensation that gives them peace of mind and bliss they cannot - and even do not want to - do without. Keeping this "transitional object" raises a dual question as to the nature and status of the object on the one hand and, on the other, the existence of a fetishism typical of women, therefore associated with a specific erotic dimension.

Elles ont 20, 30, 40 ou 70 ans, et ont la particularité d'avoir conservé un objet transitionnel, un "doudou", petit bout de tissu ou de peluche élimé remontant à la petite enfance, qui leur procure une sensation "unique", convoquant un sentiment de quiétude et de béatitude, dont elles ne peuvent - ni ne veulent - se passer. Cette persistance de "l'objet transitionnel" ouvre une double interrogation sur, d'une part, la nature et le statut de cet objet et, d'autre part, sur l'existence d'un fétichisme spécifique, propre au sexe féminin, et convoquant, de ce fait, une érotique singulière.

Ellas tienen veinte, treinta, cuarenta o setenta años y tienen todas una misma particularidad: han conservado un objeto transicional, un muñeco, un trapo, un peluche muy usado que remonta a su niñez y que les da una sensación "única", un sentimiento de beatitud y alegría al que no pueden - o no quieren - renunciar. Tal persistencia del "objeto transicional" plantea un doble interrogante: el de la naturaleza y estatus de ese objeto y el de la existencia de un fetichismo específico, propio del sexo femenino, con su erótica singular.