Follow-up of children exposed antenatally to immunosuppressive drugs

Antenatal exposure to immunosuppressive drugs given to mothers during pregnancy to treat autoimmune diseases raises some questions about the fetal development and the long-term outcome of children. Studies in humans showed that glucocorticoids (GCs), CsA and HCQ do not seem to increase the risk of congenital abnormalities; in contrast, cyclophosphamide, LEF and MTX are contraindicated during pregnancy. The risk of gestational complications, including pre-term delivery, intrauterine growth retardation (IUGR) and low birth weight (LBW), is higher in autoimmune diseases rather than in the general population and probably this finding is related to both maternal disorder and immunosuppressive therapy. Recently, results of our studies suggest that immunosuppressants given during pregnancy do not impair significantly the development of immunity in exposed children. Moreover, preliminary data on neurodevelopmental outcome seem to exclude a causative role of in utero exposure to immunosuppressive agents on the cognitive impairment observed in some of these children; however, our data need to be confirmed with further observations.