Effects of immunosuppressive drugs during pregnancy

Bermas, Bonnie L.; Hill, Joseph A.

doi:10.1002/art.1780381203

Cited by 125 publications

(75 citation statements)

References 87 publications

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“…Therefore, these findings showed the ability of CsA to cross the placenta and the importance of controlling the drug level and its metabolites as previously reported by several authors (Nyberg et al 1998;Venkataramanan et al 1988). These data agree with our report and other previous reports indicating that this drug and its metabolites interfere with fetal development (Bermas and Hill 1995;Sgro et al 2002;Tendron-Franzin et al 2004). TendronFranzin et al (2004) also showed that the rabbits exposed in utero to CsA initially had, at 1 month of age, a normal arterial blood pressure, but at 11 weeks they developed a marked systemic hypertension worsening with age.…”

Section: Discussionsupporting

confidence: 94%

Protective Role of Polyphenols in Cyclosporine A-induced Nephrotoxicity During Rat Pregnancy

Rezzani

Rodella

Tengattini

et al. 2006

J Histochem Cytochem.

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The aim of this study was to evaluate the adverse effects of cyclosporine A (CsA) toward renal morphogenesis and to test the renoprotective natural antioxidants such as provinol (PV). Pregnant rats were divided into four groups. Group I was injected SC with olive oil. Group II was treated with oral administration of PV and was used as control. Group III animals were injected SC daily with CsA, and group IV animals were injected daily with CsA and PV for 21 days of pregnancy. Five pups per litter were killed and the kidneys removed and treated by morphological and immunohistochemical (IHC) methods. IHC analysis considered two proteins responsible for nephrotoxicity in adult rats: inducible nitric oxide (iNOS) and matrix metalloproteinase-2 (MMP2). Pregnancy outcomes among CsA-treated rats demonstrated a reduced number of pups. Pups that were exposed antenatally to CsA presented several pathologic findings in all immature parenchyma and an increase in iNOS and MMP2 expression. These side effects were not observed in kidney of litters born from CsA + PV-treated mothers. Our study indicates that CsA induces morphological alterations in renal parenchyma of neonates and that PV plays a protective role against these side effects.

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Section: Discussionsupporting

confidence: 94%

Protective Role of Polyphenols in Cyclosporine A-induced Nephrotoxicity During Rat Pregnancy

Rezzani

Rodella

Tengattini

et al. 2006

J Histochem Cytochem.

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“…This observation suggested concern of the potential teratogenic side effect of IS agents would be the obstacle for women to commence with the IS therapy. Thiopurine, the most commonly used IS in CD, is reported to be of low risk during pregnancy (4,30,41) . But, the label of relative contraindication for peri-conceptional use of thiopurines is still pointed out by the pharmaceutical companies in the drug information sheet, which might be a barrier to patients with an active desire to conceive (3,6,10) .…”

Section: Discussionmentioning

confidence: 99%

GENDER-RELATED DIFFERENCES IN CLINICAL COURSE OF CROHN’S DISEASE IN AN ASIAN POPULATION: a retrospective cohort review

Law¹,

Li²

2014

Arq. Gastroenterol.

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“…Fluorinated steroids, betamethasone and dexamethasone are less efficiently metabolized by the placenta compared to prednisolone, resulting in fetal levels 10%-12% of that in maternal serum [47] . While breastfeeding is safe with steroid use, mothers are encouraged to defer breastfeeding until 4 h after taking oral dosing of steroids to reduce neonatal exposure [48] . There is no data on the safety of oral budesonide in pregnancy.…”

Section: Corticosteroids (Fda Class C)mentioning

confidence: 99%

“…It is most likely safe with no adverse fetal effects during pregnancy. Most of the data regarding the use of cyclosporine comes from transplant patients [48,56] . CsA is a highly toxic drug for the mother with risk of hypertension, nephrotoxicity and hepatotoxicity.…”

Section: Immunomodulatorsmentioning

confidence: 99%

Management of inflammatory bowel disease in the pregnant patient

Habal¹,

Ravindran²

2008

WJG

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general population due to relationship difficulties, body image problems, fear of pregnancy and inappropriate medical advice that pregnancy might be dangerous [1][2][3] . Pregnancy planning should be discussed with the patient and her partner early on prior to conception. Education and open communication are important as patients may be reluctant to broach this topic on their own. Patient concerns often relate to fertility, impact of IBD on pregnancy and fetal development, and drug effects pre-conception, during pregnancy and while breastfeeding. FERTILITYWomen with ulcerative colitis (UC) who have not undergone surgery or those with inactive Crohn's Disease (CD) have fertility rates comparable with the rest of the population. In comparison, women with UC who have had surgery [4] or those with active CD [5,6] have increased infertility. Fertility appears to revert to normal after induction of remission in women with CD. Women who have their first pregnancy after the onset of IBD have fewer pregnancies than population controls, whereas women who became pregnant prior to onset of IBD have similar reproductive history [5] . In addition, women with CD have a delayed age of first pregnancy after being diagnosed [7] and have been shown to have fewer children than might be expected after diagnosis with a higher rate of failure to conceive [8] . IMPACT OF IBD ON PREGNANCY AND FETAL DEVELOPMENTT he initial impression looking at multiple, small observational studies of pregnancy in women with IBD was that the outcome was normal [6,9] . Fetal mortality risk (spontaneous abortion, stillbirth or neonatal death) is not higher for IBD patients [3] , but there is an increased risk of preterm delivery (< 37 wk) and low birth weight (< 2.5 kg) in mothers with IBD [10][11][12][13][14] . Still, the majority of women with IBD will have a normal outcome of pregnancy. Disease activity is the main adverse factor predisposing to prematurity and low birth weight babies [15] . DISEASE ACTIVITYApproximately one-third of women with inactive IBD at conception will relapse during the pregnancy or puerperium. Management of inflammatory bowel disease in the pregnant patient AbstractInflammatory bowel disease (IBD) is a chronic disorder affecting young adults in their reproductive years. Many young women with IBD express concern about the effect their disease will have on fertility, pregnancy course and fetal development. This article presents an approach to management of IBD in the pregnant patient, including counseling and investigation, and summarizes existing data on the safety of medications used to treat IBD in pregnancy and breastfeeding.

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Effects of immunosuppressive drugs during pregnancy

Cited by 125 publications

References 87 publications

Protective Role of Polyphenols in Cyclosporine A-induced Nephrotoxicity During Rat Pregnancy

Protective Role of Polyphenols in Cyclosporine A-induced Nephrotoxicity During Rat Pregnancy

GENDER-RELATED DIFFERENCES IN CLINICAL COURSE OF CROHN’S DISEASE IN AN ASIAN POPULATION: a retrospective cohort review

Management of inflammatory bowel disease in the pregnant patient

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