In utero exposure to immunosuppressive drugs.
The number of pregnant women receiving immunosuppressants for anti-rejection therapy or autoimmune diseases is increasing. All immunosuppressive drugs cross the placenta, raising questions about the long-term outcome of the children exposed in utero. There is no higher risk of congenital anomalies. However, an increased incidence of prematurity, intrauterine growth retardation (IUGR) and generally low birth weight has been reported, as well as maternal hypertension and preeclampsia. The most frequent neonatal complications are those associated with prematurity and IUGR, as well as adrenal insufficiency with corticosteroids, immunological disturbances with azathioprine and cyclosporine, and hyperkalemia with tacrolimus. The long-term follow-up of infants exposed to immunosuppressants in utero is still limited and experimental studies raise the question whether there could be an increased incidence at adult age of some pathologies including renal insufficiency, hypertension and diabetes.
Prévot
Anne
A
Department of Pediatrics, Pediatric Nephrology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. prevotanne@hotmail.com
Martini
Stephan
S
Guignard
Jean-Pierre
JP
D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008431:Maternal-Fetal Exchange / Q000502:physiology*; D011247:Pregnancy
D007166:Immunosuppressive Agents