[Immunosuppressants for auto-immune diseases and pregnancy]

Therapeutic stability of a systemic disease is a priority during pregnancy. To stop an effective treatment, to reduce dosages or to switch to less effective treatments might induce some loss of chance for pregnant women, and eventually harmful consequences for fetuses. Due to the teratogenic effects of some immunosuppressants, childbearing susceptible women should use effective contraception and be informed of risks in case of pregnancy. A pre-conceptional consultation is of interest, allowing an adaptation of treatment and advices before pregnancy is ongoing. Mycophenolate is highly suspected to be teratogenic in humans. Mycophenolate should not be prescribed in women of childbearing potential unless some criteria are met. Maternal (even fetal) infectious conditions can occur during immunosuppressive treatments. Therefore, obstetricians and pediatricians should be aware of the maternal treatment in order to allow adequate monitoring of the mother and the neonate.