A 32-year-old woman is 2 years post-renal transplant with stable graft function (eGFR 60 ml/min), no recent episodes of rejection, no proteinuria, and well-controlled hypertension. Her current medications include tacrolimus, mycophenolate mofetil, prednisone, and ramipril. She has come to clinic because she wishes to get pregnant.
Which of her medications are contraindicated in pregnancy?
There are no randomized controlled trials addressing the safety of immunosuppressive drugs pregnancy, and the available data is limited. In this patient, tacrolimus and prednisone would be considered safe to continue. However, a higher incidence of birth defects has been seen in women who were taking either mycophenolate mofetil or sirolimus during their pregnancy. Ramipril (and all ACE-inhibitors and angiotensin-receptor blockers) are contraindicated during pregnancy due to the risk of renal agenesis.