Intrauterine exposure to mycophenolate mofetil and multiple congenital anomalies in a newborn: Possible teratogenic effect

Jackson, Paige; Paquette, Lisa; Watiker, Valerie; Randolph, Linda M.; Ramanathan, Rangasamy; Seri, István

doi:10.1002/ajmg.a.32715

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…[4] Examples include fulminant hepatic failure from hepatitis B in patients taking B-cell depleting therapies without appropriate preventive measures, [38,39] reactivation of latent tuberculosis in patients taking anti-TNF therapies, [40,41] and unintended pregnancies in women using teratogenic medications who may not have received adequate contraceptive counseling. [42,43,44,45]…”

Section: Improving Medication Safety For Patients Receiving High-riskmentioning

confidence: 99%

Leveraging the electronic health record to improve quality and safety in rheumatology

Schmajuk

Yazdany

2017

Rheumatol Int

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During the last two decades, improving the quality and safety of healthcare has become a focus in rheumatology. Widespread use of electronic health records (EHRs) and the availability of digital data have the potential to drive quality improvement, improve patient outcomes, and prevent adverse events. In the coming years, developing and leveraging tools within the EHR will be the key to making the next big strides in improving the health of patients with rheumatoid arthritis and other rheumatic diseases, including building EHR infrastructure to capture patient outcomes and developing automated methods to retrieve information from free text of clinical notes.

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Section: Improving Medication Safety For Patients Receiving High-riskmentioning

confidence: 99%

Leveraging the electronic health record to improve quality and safety in rheumatology

Schmajuk

Yazdany

2017

Rheumatol Int

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“…An increased incidence of characteristic birth defects has been recognized as a sequela of MPA exposure during pregnancy . Discontinuing MPA >6 weeks prior to pregnancy has been shown to avert the risk of having MPA‐associated birth defects .…”

Section: Discussionmentioning

confidence: 99%

“…Recent database and observational studies have shown that maternal MPA exposure during pregnancy is associated with increased rates of miscarriages and characteristic congenital anomalies. Data from the National Transplantation Pregnancy Registry (NTPR) and other case series reports have shown high prevalence of microtia, colobomas, craniofacial malformations, cardiac defects and esophageal atresia in newborns of mothers exposed to MPA during their first trimester of pregnancy . Miscarriage rates in the transplant population are estimated to be 13–22%, whereas the NTPR and others have reported estimated miscarriage rates for mothers exposed to MPA during their first trimester to be 28–64% .…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes Related to Mycophenolate Exposure in Female Kidney Transplant Recipients

King

Baca

Armenti

et al. 2017

American Journal of Transplantation

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In 2012, the U.S. Food and Drug Administration issued guidelines advising kidney transplant recipients (KTRs) to discontinue mycophenolate (MPA) in preparation for pregnancy. Little is known about how this guidance has affected pregnancy and graft outcomes. The purpose of this retrospective cohort study was to investigate any association between the discontinuation of MPA and KTR pregnancy and graft outcomes. Data from the National Transplantation Pregnancy Registry included 382 cases in which KTRs managed on MPA became pregnant. Overall, 22 variables, including the time in which a KTR discontinued MPA, were assessed across four end points: miscarriages, birth defects, and 2-and 5-year postpartum graft loss. Birth defects and miscarriages were similar among KTRs who discontinued MPA >6 and <6 weeks prior to pregnancy and during the first trimester. In contrast, discontinuing MPA during the second trimester or later significantly increased the risk of miscarriages (odds ratio [OR] 9.35, 95% confidence interval [CI] 4.31-20.00, p < 0.001) and birth defects (OR 6.06, p = 0.002). Discontinuing MPA <6 weeks prior to pregnancy was associated with an increased risk of 5-year graft loss. For the fetus, there is value to discontinuing MPA anytime prior to the second trimester. Adhering to current guidelines does not negatively affect graft survival.

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“…Immunosuppression requirements frequently change during pregnancy with changing metabolism and volumes of distribution of the drugs (26, 31, 34, 35), and careful monitoring of graft function and calcineurin inhibitor levels is essential. MMF and mycophenolic acid which are associated with an increased risk of spontaneous abortions and a definite pattern of congenital malformations (microtia, cleft palate and lip, micrognathia, hypertelorism and abnormalities of the eyes, distal limbs, heart, esophagus, and kidney) should not be used during pregnancy (7, 13–18). It is recommended that women of childbearing age should use contraception while taking MMF or mycophenolic acid (19, 20).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy following liver transplantation during childhood and adolescence

Spearman

Goddard

McCulloch

et al. 2011

Pediatric Transplantation

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More than 80% of pediatric transplant recipients will survive to reach adulthood, and many will consider having children. We report on outcomes and management of five pregnancies in four women undergoing orthotopic liver transplantation during childhood or adolescence and followed up at our Transplant Center. A retrospective clinical folder audit was performed. Mean age at transplantation was 13.3 ± 3.4 yr (range, 10-18 yr). Mean interval between transplantation and pregnancy was 15.4 ± 4.9 yr (range, 10-22 yr). Mean maternal age at conception was 28 ± 3.5 yr (range, 23-32 yr). Mean gestational age was 36.6 ± 1.7 wk. Mean birth weight was 2672 ± 249 g. Immunosuppression was cyclosporin based in three women and tacrolimus based in one woman. Pregnancy complications necessitating the induction of labor included fetal distress and rising maternal liver enzymes in two women, cholestasis of pregnancy and impaired renal graft function in one woman, fetal distress and preeclampsia in one woman. Modes of delivery were normal vaginal delivery in three women and cesarean section in one woman. No maternal or fetal deaths and no congenital malformations occurred. No episodes of rejection occurred during pregnancy. Two women experienced acute cellular rejection requiring an increase in baseline immunosuppression in the first year, following delivery. No graft losses occurred during a mean follow-up of 44 ± 17.9 months post-delivery. With careful management, pregnancy post-liver transplantation can have a successful outcome.

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Intrauterine exposure to mycophenolate mofetil and multiple congenital anomalies in a newborn: Possible teratogenic effect

Cited by 24 publications

References 18 publications

Leveraging the electronic health record to improve quality and safety in rheumatology

Leveraging the electronic health record to improve quality and safety in rheumatology

Pregnancy Outcomes Related to Mycophenolate Exposure in Female Kidney Transplant Recipients

Pregnancy following liver transplantation during childhood and adolescence

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