Skip to main content

Maternal Use of Immunostimulating or Immunosuppressive Drugs and Infant Congenital Malformations

  • Chapter
  • First Online:
Maternal Drug Use and Infant Congenital Malformations
  • 390 Accesses

Abstract

Available information on the use of immunostimulating and immunosuppressive drugs during pregnancy is limited. It is generally argued that with the exception of mycophenylate mofetil no certain teratogenic effect is seen of these drugs. The data presented here indicate that use of azathioprine or its active metabolite 6-mercaptopurine is associated with an increased risk of cardiac septum defects and perhaps of hypospadias. Similarly, tacrolimus is generally regarded as without risk for congenital malformations but in a rather small material an increased risk seemed to exist but it was based on few exposed cases and needs confirmation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ban L, Tata LJ, Fiaschi L, Card T. Limited risks of major congenital malformations in children of mothers with IBD and effects of medication. Gastroenterology. 2014;146:76–84.

    Article  CAS  Google Scholar 

  • Bar-Oz B, Hackman R, Einarson T, Koren G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis. Transplantation. 2001;71:1051–5.

    Article  CAS  Google Scholar 

  • Bazzani C, Scrivo R, Andreoli L, Baldissera E, Biggioggero M, Canti V, Gerosa M, Pontikaki I, Ramon V, Trespidi L, Zatti S, Caporali T, Gloria R, Iannone F, Lojacono A, Meroni P, Montecucco C, Motta M, Sabbadini MG, Valesini G, Tincani A. Prospectively followed pregnancies in patients with inflammatory arthritis taking biological drugs: an Italian multicenter study. Clin Exp Rheumatol. 2015;33:688–93.

    PubMed  Google Scholar 

  • Boskovic R, Wilde R, Wolpin J, Bauer D, Koren G. The reproductive effect of beta interferon in pregnancy: a longitudinal cohort. Neurology. 2005;65:807–11.

    Article  CAS  Google Scholar 

  • Bröms G, Granath F, Ekbom A, Hellgren K, Pedersen L, Sørensen HT, Stephansson O, Kieler H. Low risk of birth defects for infants whose mothers are treated with anti-tumor necrosis factor agents during pregnancy. Clin Gastroenterol Hepatol. 2016;14:234–41.

    Article  Google Scholar 

  • Carman WJ, Accortt NA, Anthony MS, Iles J, Enger C. Pregnancy and infant outcome including major congenital malformations among women with chronic inflammatory arthritis and psoriasis, with and without etanercept use. Pharmacoepidemiol Drug Saf. 2017;26:1109–15.

    Article  Google Scholar 

  • Carter JD, Ladhani A, Ricca LR, Valeriano J, Vasey FB. A safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drug Administration database. J Rheumatol. 2009;36:635–41.

    Article  Google Scholar 

  • Carter JD, Valeriano J, Vasey FB. Tumor necrosis factor-α inhibition and VATER association: a causal relationship? J Rheumatol. 2006;33:1014–7.

    PubMed  Google Scholar 

  • Cassina M, Johnson DL, Robinsom LK, Braddock SR, Jimenez JL, Mirrasoul N, Salas E, Luo YJ, Jones KL, Chambers CD. Pregnancy outcome in women exposed to lefluonomide before or during pregnancy. Arthritis Rheum. 2012;64:2085–94.

    Article  CAS  Google Scholar 

  • Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Lopez-Jimenez J, Mirrasoul N, Salas E, Luo YJ, Jin S, Jones KL. Birth outcomes in pregnant women taking leflunomide. Arthritis Rheum. 2010;62:1494–53.

    Article  Google Scholar 

  • Cleary BJ, Källén B. Early pregnancy azathioprine use and pregnancy outcome. Birth Defects Res A Clin Mol Teratol. 2009;85:647–54.

    Article  CAS  Google Scholar 

  • Clowse MEB. The use of anti-TNFα medications for rheumatologic disease in pregnancy. Int J Womens Health. 2010;2:199–209.

    Article  CAS  Google Scholar 

  • Clowse MEB, Scheuerie AE, Chambers C, Afzan A, Kimball AB, Cush JJ, Cooney M, Shaughnessy L, Vanderkelen M, Förger F. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol. 2018;70(9):1399–407. https://doi.org/10.1002/art.40508.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Coffin CS, Shaheen AA, Burak KW, Myers RP. Pregnancy outcomes among liver transplant recipients in the United States: a nationwide case-control analysis. Liver Transpl. 2010;16:56–63.

    Article  Google Scholar 

  • Cooper WO, Cheethham TC, Li D-K, Stein M, Callahan T, Morgan TM, Shintani AK, Chen N, Griffin MR, Ray WA. Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune mediated diseases. Arthritis Rheumatol. 2014;66:444–50.

    Article  Google Scholar 

  • Coyle PK, Sinclair SM, Scheuerle AE, Thorpt JM, Albano JD, Rametta MJ. Final results of the Betaseron (interferon β-1b) pregnancy registry: s prospective observational study of birth defects and pregnancy-related adverse events. BMJ Open. 2014;4:e004536. https://doi.org/10.1136/bmjopen-2013-004538.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ghazali S, Cruzoi-Shulman N, Spence AR, Mishkin DS, Abenhaim HA. Pregnancy outcome in liver transplant patients, a population-based study. J Matern Fetal Neonatal Med. 2017;30:261–6.

    Article  Google Scholar 

  • Hellwig K, Gold R. Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J Neurol. 2011;258:502–3.

    Article  Google Scholar 

  • Hoeltzenbein M, Elefant E, Vial T, Finkel-Pekarsky V, Stephens S, Clementi M, Allignol A, Weber-Schoendorfer C, Schaefer C. Teratogenicity of mycophenolate confirmed in a prospective study of the European Network of Teratology Information Services. Am J Med Genet A. 2012;158A:588–96.

    Article  Google Scholar 

  • Kainz A, Harabacz I, Cowlrick IS, Gadoil SD, Hagiwara D. Review of the course and outcome of 100 pregnancies in 84 women treated with tacrolimus. Transplantation. 2000;70:1718–21.

    Article  CAS  Google Scholar 

  • Källén B, Westgren M, Åberg A, Otterblad Olausson P. Pregnancy outcome after maternal organ transplantation in Sweden. BJOG. 2005;112:904–9.

    Article  Google Scholar 

  • Katz JA, Antoni C, Keenan GF, Smith DE, Jacobs SJ, Lichtenstein GR. Outcome of pregnancy in women receiving infliximab for the treatment of Crohn’s disease and rheumatoid arthritis. Am J Gastroenterol. 2004;99:2385–92.

    Article  Google Scholar 

  • Langagergaard V, Pedersen L, Gislum M, Nørgård B, Sørensen HT. Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: a Danish nationwide cohort study. Aliment Pharmacol Ther. 2007;25:73–81.

    Article  CAS  Google Scholar 

  • Marchioni RM, Lichtenstein GR. Tumor necrosis factor-α inhibitor therapy and fetal risk: a systematic literature review. World J Gastroenterol. 2013;19:2591–602.

    Article  CAS  Google Scholar 

  • Nørgård B, Pedersen L, Christensen LA, Sørensen HT. Therapeutic drug use in women with Crohn’s disease and birth outcomes: a Danish nationwide cohort study. Am J Gastroenterol. 2007;102:1406–13.

    Article  Google Scholar 

  • Nørgård B, Pedersen L, Fonager K, Rasmussen SN, Sørensen HT. Azathioprine, mercaptopurine and birth outcome: a population-based cohort study. Aliment Pharmacol Ther. 2003;17:827–34.

    Article  Google Scholar 

  • Perez-Aytes A, Ledo A, Boso V, Săenz P, Roma E, Poveda JL, Vento M. In utero exposure to mycophenolate mofetil: a characteristic phenotype. Am J Med Genet A. 2008;146A:1–7.

    Article  Google Scholar 

  • Perez-Aytes A, Marin-Reina P, Boso V, Ledo A, Carey JC, Vento M. Mycophenolate mofetil embryopathy: a newly recognized teratogenic syndrome. Eur J Med Genet. 2017;60:16–21.

    Article  Google Scholar 

  • Pergola PE, Kancharia A, Riley DJ. Kidney transplantation during the first trimester of pregnancy: immunosuppression with mycophenolate mofetil, tacrolimus, and prednisone. Transplantation. 2001;71:994–7.

    Article  CAS  Google Scholar 

  • Saavedra MA, Sánchez A, Morales S, Ángeles U, Jara LJ. Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor outcome. Clin Rheumatol. 2015;34:1211–6.

    Article  Google Scholar 

  • Salminen HJ, Leggett H, Boggild M. Glatiramer acetate exposure in pregnancy: preliminary safety and birth outcomes. J Neurol. 2010;257:2020–3.

    Article  CAS  Google Scholar 

  • Sandberg-Wolheim M, Alteri E, Moraga MS, Kommann G. Pregnancy outcome in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult Scler. 2011;17:423. https://doi.org/10.1177/135245851Pere0394610.

    Article  Google Scholar 

  • Sandberg-Wolheim M, Frank D, Goodwin TM, Giesser B, Lopez-Bresnahan M, Stam-Moraga M, Chang P. Pregnancy outcomes during treatment with interferon beta-1a in patients with multiple sclerosis. Neurology. 2005;65:802–6.

    Article  Google Scholar 

  • Sebaaly Z, Charpentier B, Snanoudj R. Fetal malformations associated with mycophenolate mofetil for lupus nephritis. Nephrol Dial Transplant. 2007;22:2722–32.

    Article  Google Scholar 

  • Seirafi M, de Vroey B, Amiot A, Seksik P, Roblin X, Allez M, Peyrin-Biroulet L, Marteau P, Cadiot G, Laharie D, Boureille A, De Vos M, Savoye G, Rahier J-F, Carbonnel F, Bonaz B. Factors associated with pregnancy outcome in anti-TNF treated women with inflammatory bowel disease. Aliment Pharmacol Ther. 2014;40:363–73.

    Article  CAS  Google Scholar 

  • Shihab Z, Yeomans ND, De Cruz P. Anti-tumour necrosis factor α therapies and inflammatory bowel disease pregnancy outcomes: a meta-analysis. J Crohns Colitis. 2016;10:979–88. https://doi.org/10.1093/ecco-jcc/jjv234.

    Article  PubMed  Google Scholar 

  • Sifontis NM, Coscia LA, Constatinescu S, Lavelanet AF, Mortiz MJ, Armenti VT. Pregnancy outcomes in solid organ transplanted recipients with exposure to mycophenolate mofetil or sirolimus. Transplantation. 2006;82:1698–702.

    Article  CAS  Google Scholar 

  • Thiel S, Langer-Gould A, Rockhoff M, Haghikia A, Queisser-Wahrendorf A, Gold R, Hellwig K. Interferon-beta exposure during first trimester is safe in women with multiple sclerosis—a prospective cohort study from the German Multiple Sclerosis and Pregnancy Registry. Mult Scler. 2016;22:801–9.

    Article  CAS  Google Scholar 

  • Van den Berg SA, de Boer M, van der Meulen-de Jong AE, Jansen JM, Hoentjen E, Russel MG. Safety of tioguanine during pregnancy in inflammatory bowel disease. J Chrons Colitis. 2016;10:159–65.

    Article  Google Scholar 

  • Weber-Schoendorfer C, Opperman M, Wacker E, Bernard N. Pregnancy outcome after TNF-α inhibitor therapy during the first trimester: a prospective cohort study. Br J Clin Pharmacol. 2015;80:727–39.

    Article  CAS  Google Scholar 

  • Weber-Schoendorfer C, Schaefer C. Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler. 2009;15:1037–42.

    Article  CAS  Google Scholar 

  • Vento M, Perez Aytes A, Ledo A, Boso V, Carey JC. Mycophenolate mofatil during pregnancy: some words of caution. Pediatrics. 2008;122:184. https://doi.org/10.1542/peds.2008-0348r.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Källén, B. (2019). Maternal Use of Immunostimulating or Immunosuppressive Drugs and Infant Congenital Malformations. In: Maternal Drug Use and Infant Congenital Malformations. Springer, Cham. https://doi.org/10.1007/978-3-030-17898-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17898-7_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17897-0

  • Online ISBN: 978-3-030-17898-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics