Pregnancy and lactation considerations of common immunosuppresant drugs
| Medication | Pregnancy exposure registry information | Pregnancy category | Lactation considerations |
|---|---|---|---|
| Prednisone | Crosses the placenta Can cause clefts and decreased birth weight when used in the first trimester When needed: can consider using the lowest effective dose for the shortest possible time in the second and third trimesters | C or D, depending on the trimester and dose | Excreted in breast milk Potential for adverse events; risk-benefit assessment needed |
| Mycophenolate mofetil | Increased risk of first-trimester pregnancy loss and congenital malformations | D | Little information available, but breast-feeding not recommended |
| Azathioprine | Crosses the placenta Congenital anomalies, immunosuppression, and intrauterine growth retardation have been reported Pregnancy should be avoided during treatment | D | Breast-feeding not recommended, given adverse effects and excretion in breast milk |
| Cyclosporine | Crosses the placenta Can lead to premature birth and low birth weight Should be avoided during the first trimester | C | Excreted in milk; risk-benefit assessment needed |
| Tacrolimus | Crosses the placenta Can cause low birth weight, neonatal hyperkalemia, and neonatal renal dysfunction | C | Breast-feeding not recommended, given adverse effects and excretion in breast milk |
| Everolimus | Crosses the placenta May cause fetal harm Pregnancy should be avoided Birth control should be continued for 8 weeks following drug cessation | C | Not known whether it is excreted in breast milk; breast-feeding not recommended |
| Sirolimus | Adverse events have been observed in animal studies. | C | Not known whether it is excreted in breast milk; risk-benefit assessment needed |
| Belatacept | Adverse events have been observed | C | Not known whether it is excreted in breast milk; breast-feeding not recommended |
Based on information from reference 18.