Table 4

Immunosuppression safety in pregnancy and breast feeding

PericonceptionT1T2/T3Breast feedingPaternal exposure
Prednisolone36 YesYesYesYesYes
Intravenous MP36 YesYesYesYesYes
AZA38 YesYesYesYesYes
MTX≤25 mg/week38 39 Stop 1 month in advanceNoNoNoYes
MMF38 Stop 6 weeks in advanceNoNoNoSee text
CYC38 NoNo*No*NoNo
Intravenous Ig37 38 YesYesYesYesYes†
Rituximab7 38 Consider stopping at conception‡Severe disease if no alternatives‡Severe disease if no alternatives§Yes†Yes†
  • *Only consider in severe life or organ-threatening maternal disease.

  • †Limited data available.

  • ‡Can consider in severe maternal disease if no pregnancy-compatible alternatives available.

  • §If used in third trimester, avoid live vaccinations in infant until 6 months of age.

  • AZA, azathioprine; CYC, cyclophosphamide; Ig, immunoglobulin; MMF, mycophenolate mofetil; MP, methylprednisolone; MTX, methotrexate.