Esophageal atresia and prenatal exposure to mycophenolate

Area of Science:

• Immunology
• Teratology
• Developmental Biology

Background:

• Mycophenolate mofetil (MMF) is an immunosuppressant used in organ transplantation and autoimmune diseases.
• Previous studies have indicated potential teratogenic effects of MMF following in utero exposure.
• The full spectrum of MMF embryopathy is still under investigation.

Observation:

• This report details four newborns with esophageal atresia and other congenital anomalies.
• All four infants had prenatal exposure to MMF during the first trimester.
• Two cases exhibited additional defects consistent with MMF embryopathy, including microtia, ocular abnormalities, and oral clefts.

Findings:

• Esophageal atresia, with or without tracheoesophageal fistula, is proposed as a potential feature of MMF embryopathy.
• This association may be present even in the absence of other major craniofacial anomalies.
• The findings reinforce the teratogenicity of MMF in humans.

Implications:

• Clinicians should be aware of the potential for esophageal atresia in infants exposed to MMF during pregnancy.
• Current recommendations for contraception in women of childbearing potential using MMF are critical.
• Further research is needed to fully delineate the risks and clinical patterns of MMF embryopathy.