title: Immunosuppression in pregnant women with systemic lupus erythematosus.
abstract: Most pregnancies are successful in women with systemic lupus erythematosus, particularly if the disease is quiescent and there are no signs of active nephritis. There is no major impact of immunosuppression on maternal outcome. However, high doses of cyclosporine and glucocorticoids are used which may favor development of hypertension or preeclampsia. Some immunosuppressive drugs may exert toxic effects on the fetus. Glucocorticoids may cause small birth weight, and azathioprine and calcineurin inhibitors may be associated with lower birth weight, gestational age and prematurity. Cyclophosphamide may cause fetal malformation when given in the first trimester. Mycophenolate and leflunomide are teratogenic drugs and should be withdrawn before conception in case of programmed pregnancy or should be rapidly discontinued in case of unexpected pregnancy. Option counseling for pregnancy and correct use of immunosuppressive drugs are prerequisites for a successful pregnancy in women with lupus.
authors.affiliation: Nephrology Unit, Clinical and Research Center Humanitas, via Manzoni 56, 20089 Rozzano, Milano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ponticelli
authors.forename: Gabriella
authors.initials: G
authors.lastname: Moroni
mesh_terms: D000075202:Contraindications; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000517:prevention & control*; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007555:Isoxazoles; D000077339:Leflunomide; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D018811:Maternal Exposure / Q000009:adverse effects; D009173:Mycophenolic Acid / Q000031:analogs & derivatives; D011225:Pre-Eclampsia / Q000139:chemically induced / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D028761:Withholding Treatment
chemical_list: D005938:Glucocorticoids; D007555:Isoxazoles; D016572:Cyclosporine; D000077339:Leflunomide; D009173:Mycophenolic Acid
keywords: autoimmune diseases; immunosuppression; lupus nephritis; pregnancy; systemic lupus erythematosus; teratogenic drugs