mycophenolic-acid and Stillbirth

Autoimmune hepatitis (AIH) in pregnancy has many unique considerations. Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period. Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

Topics: Female; Hepatitis, Autoimmune; Humans; Immunosuppression Therapy; Infant, Newborn; Mycophenolic Acid; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Stillbirth

To evaluate the relative risk of pregnancy loss associated with mycophenolate (MPA) vs azathioprine (AZA) use.. We conducted a retrospective cohort study using the IBM MarketScan Research Databases (2005-2015). Patients with ≥1 MPA or AZA prescription claim during the first trimester were included. The study outcome was pregnancy loss (spontaneous abortion or stillbirth). Potential confounders included age, drug indications, comorbidities, other teratogenic medication use, and gestational age at first MPA or AZA prescription fill. The risk for pregnancy loss was estimated using a generalized estimating equation model with stabilized inverse probability of treatment weighting. In sensitivity analyses, we varied the exposure definition, outcome definition, and the analytical method.. Among 111 pregnancies exposed to MPA, 55 resulted in pregnancy loss (49.5%). Among 471 pregnancies exposed to AZA, 113 had pregnancy loss (24.0%). The unadjusted relative risk for pregnancy loss was 2.0 (95% CI 1.6, 2.6), and the adjusted relative risk was 1.9 (95% CI, 1.6, 2.3) compared to AZA. Relative risk estimates were stable in all sensitivity analyses.. Exposure to MPA during early pregnancy was associated with a 2-fold increase in pregnancy loss risk.

Topics: Abortion, Spontaneous; Adolescent; Adult; Azathioprine; Child; Databases, Factual; Female; Humans; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Pregnancy; Retrospective Studies; Risk Assessment; Risk Factors; Stillbirth; Young Adult

To assess maternal, neonatal and graft outcomes after pregnancy in patients with kidney transplantation, and to compare the immunosuppressive therapies used.. Review of 29 pregnancies in 23 patients with kidney transplantation, managed at La Fe University Hospital, Valencia. Immunosuppressive therapies with Cyclosporine-A, Tacrolimus, Mycophenolate mofetil and Azathioprine were compared.. No statistical differences were found in perinatal or maternal complications, with respect to the immunosuppressive therapy used. There were no differences between therapy and graft survival. Maternal complications occurred in 25 out of 28 deliveries. The most common were anemia (75%) and hypertension (53.6%). Of the 29 pregnancies, 26 were live deliveries, two were stillbirths and one was a miscarriage. The median birth weight of newborns was 2650 g (900-4350 g). From the 28 deliveries, maternal complications were reported in 25 patients. Perinatal complications were recorded in 55.6% of the patients, with prematurity being the most common (44.4%) type. One malformation was reported, this was a cleft palate in a 25 year old patient who was treated with mycophenolate mofetil.. Pregnancies in patients with kidney transplantation should be considered high-risk pregnancies because of the higher rate of maternal and perinatal complications. Immunosuppressive therapies have not shown differences in maternal or perinatal outcomes.

Topics: Abortion, Spontaneous; Adult; Azathioprine; Cyclosporine; Female; Graft Survival; Humans; Immunosuppressive Agents; Infant, Newborn; Kidney Transplantation; Mycophenolic Acid; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Stillbirth; Tacrolimus; Transplantation Conditioning; Young Adult