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Pregnancy increases the risk of flare in patients with SLE and is associated with excess fetal morbidity and mortality.1 The management of pregnant patients with lupus is difficult, partly because some medications used to control maternal disease are teratogenic. Thus, mycophenolate mofetil (MMF), one of the most prescribed immunosuppressive agents in SLE, has been strongly associated with an increased risk of first trimester fetal loss and congenital malformations, especially external ear and other facial abnormalities including cleft lip with or without cleft palate, external auditory canal atresia, microtia, hypertelorism and micrognathia. Anomalies of the distal limbs, heart, oesophagus, kidney and nervous system have also been described.2–4 This MMF embryopathy, affecting up to 26% of exposed babies, has been observed even with low daily doses and after a short exposure period.