J Pediatr Genet 2015; 04(02): 042-055
DOI: 10.1055/s-0035-1556743
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Update on the Teratogenicity of Maternal Mycophenolate Mofetil

Lisa A. Coscia
1  National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, Philadelphia, Pennsylvania, United States
,
Dawn P. Armenti
1  National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, Philadelphia, Pennsylvania, United States
,
Ryan W. King
2  University of Central Florida College of Medicine, Orlando, Florida, United States
,
Nicole M. Sifontis
3  Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, United States
,
Serban Constantinescu
1  National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, Philadelphia, Pennsylvania, United States
4  Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
,
Michael J. Moritz
1  National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, Philadelphia, Pennsylvania, United States
5  Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, United States
6  Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
› Author Affiliations
Further Information

Publication History

31 March 2015

01 April 2015

Publication Date:
31 July 2015 (online)

In Memoriam

This article is dedicated to Vincent T. Armenti, MD, PhD (1952–2014), the founder and principal investigator of the NTPR. His guidance and leadership allowed the NTPR to flourish and provide countless transplant recipients with scientific information on which to base their family planning decisions.

Abstract

Mycophenolic acid (MPA) products, namely mycophenolate mofetil and mycophenolate sodium, are immunosuppressive medications used to prevent rejection in solid organ transplant recipients and to treat various autoimmune disorders. Mycophenolate therapy is considered to be teratogenic based on observational studies of pregnancies exposed to MPA, which demonstrated an increased incidence of miscarriages in pregnancies exposed to MPA during their first trimester and a pattern of birth defects in the offspring of some pregnancies exposed to MPA. Herein, we have detailed case and series reports in a comprehensive literature review summarizing what is known to date regarding fetal exposure to MPA. Based on evidence from the literature, results of postmarketing surveillance, and information from registries such as the National Transplantation Pregnancy Registry in the United States, it is advised that pregnancy be avoided by women taking MPA. Preconception planning offers the opportunity to explore the alternatives to protect the mother, her transplanted organ, and minimize fetal risk. How to proceed in cases of unplanned pregnancies exposed to MPA in transplant recipients is a complex issue. Research involving large epidemiological studies is expected to be sparse as women heed the warnings about becoming pregnant on MPA. Published recommendations for managing MPA in women of childbearing potential include discontinuing the medication prior to conception, switching the MPA to another medication, or discontinuing the MPA when the pregnancy is discovered.