Reviewing the evidence for mycophenolate mofetil as a new teratogen: Case report and review of the literature

Anderka, Marlene; Lin, Angela E.; Abuelo, Dianne; Mitchell, Allen A.; Rasmussen, Sonja A.

doi:10.1002/ajmg.a.32685

Cited by 198 publications

(121 citation statements)

References 38 publications

(58 reference statements)

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“…With a mounting body of evidence indicating its teratogenicity, the drug was recently downgraded from FDA pregnancy category C to category D, implying that its use in pregnancy should be avoided (83,84). Although assigned to the same category as azathioprine, the risks associated with mycophenolate mofetil are much higher, and azathioprine is a safer alternative in patients who require treatment during pregnancy.…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or preeclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancyrelated complications. This review discusses the pathogenesis, maternal and fetal risks, and management pertinent to SLE patients with new onset or a history of LN predating pregnancy.

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Section: Immunosuppressive Therapymentioning

confidence: 99%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Although MMF has a similarly favorable, long-term toxicity profile, it should not be used during pregnancy. 41,42 Given that many patients with lupus nephritis are women of childbearing age, this difference in therapies can help individualize therapy in some patients.…”

Section: Maintenance Phase Treatment Of Proliferative Lupus Nephritismentioning

confidence: 99%

Updates on the Treatment of Lupus Nephritis

Bomback

Appel

2010

Journal of the American Society of Nephrology

157

139

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“…In 4 pregnancies, immunosuppressive medication with corticosteroids (n ϭ 4) and azathioprine (n ϭ 2) was taken for maintenance therapy after attaining remission. In 2 pregnancies in 1 woman immunosuppressive therapy after kidney transplantation with cyclosporine and corticosteroids was continued, but mycophenolate mofetil was switched to azathioprine before conception, since mycophenolate mofetil might be teratogenic (24).…”

Section: Outcome Of Pregnancy In Anca-associated Vasculitismentioning

confidence: 99%

Pregnancy in women diagnosed with Antineutrophil cytoplasmic antibody–associated vasculitis: Outcome for the mother and the child

Tuin¹,

Sanders²,

Joode³

et al. 2012

Arthritis Care & Research

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Objective. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is infrequently seen in women of childbearing age. Only a limited number of pregnancies in women with AAV have been reported, and often they were associated with complications. Methods. This was a single-center retrospective observational study. All pregnancies in women with granulomatosis with polyangiitis (Wegener's) (n ‫؍‬ 13) and microscopic polyangiitis (n ‫؍‬ 1) were included. Women of childbearing age were counseled to abstain from pregnancy during or shortly after disease activity or <1 year after cyclophosphamide treatment. Results. We described 22 pregnancies in 14 women with AAV (median age at diagnosis was 25 years [range 19 -36 years]) diagnosed between 1982-2008. The ear, nose, and throat region (71%) and kidneys (50%) were predominantly involved. All women were in remission at conception and cyclophosphamide had been administered to 9 women (15 pregnancies). The median gestational age was 39؉4 weeks, including 2 preterm deliveries. The median birth weight was 3,400 gm (1,860 -3,890 gm). Hypothyroidism occurred in 1 newborn and a cleft palate in 1 newborn of a twin pregnancy. Otherwise, the fetal outcome was excellent. Preeclampsia was diagnosed in 2 pregnancies. A caesarean section was performed in 2 patients. The median followup after the last conception was 98 months (range 11-307 months). Eight women experienced a relapse 21 months (range 7-62 months) after conception, 1 during pregnancy, and 7 after delivery. Conclusion. In this study, the pregnancy outcome in patients with AAV in remission was excellent. Pregnancy in women with AAV in remission does not seem to be associated with increased risk of relapse. Counseling, careful management, and close followup are essential in pregnant women with AAV.

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Reviewing the evidence for mycophenolate mofetil as a new teratogen: Case report and review of the literature

Cited by 198 publications

References 38 publications

Obstetric Nephrology

Obstetric Nephrology

Updates on the Treatment of Lupus Nephritis

Pregnancy in women diagnosed with Antineutrophil cytoplasmic antibody–associated vasculitis: Outcome for the mother and the child

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