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Immunosuppressant therapy during gestation

B B Little1

  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.

Seminars in Perinatology
|April 1, 1997
PubMed
Summary
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Immunosuppressants used during pregnancy can affect fetal development, potentially leading to a compromised immune system and lower birth weight in newborns. Some medications should be avoided, but risks must be weighed against the mother's health needs.

Area of Science:

  • Perinatology
  • Immunology
  • Pharmacology

Background:

  • Immunosuppressants are crucial for managing organ transplant rejection and autoimmune diseases.
  • These medications readily cross the placenta, posing potential risks to the developing fetus.
  • Maternal risks include nephrotoxicity and hepatotoxicity.

Purpose of the Study:

  • To review the safety and effects of immunosuppressant drug use during pregnancy.
  • To identify potential risks to the fetus and neonate from in utero exposure.
  • To provide guidance on managing immunosuppression in pregnant patients.

Main Methods:

  • Literature review of studies on immunosuppressant use in pregnancy.
  • Analysis of maternal and fetal side effects associated with various immunosuppressive agents.

Related Experiment Videos

  • Evaluation of risks versus benefits for specific drug classes.

    • Main Results:

    • First-trimester exposure shows no strong link to congenital anomalies, though some agents like azathioprine may slightly increase birth defect risks.
    • Second and third-trimester exposure can impair fetal immune system development, resulting in transient immune compromise.
    • Infants may experience slightly lower birth weights and potential direct toxic effects on organs like the pancreas and liver.

    Conclusions:

    • While generally safe in the first trimester, immunosuppressants pose risks to fetal immune development later in pregnancy.
    • Certain immunosuppressants (e.g., penicillamine, chloroquine) should be avoided if feasible.
    • Discontinuation of essential immunosuppressants is often not possible due to life-threatening indications.