Susac Syndrome and Pregnancy

Table 1

Summary of several medications that are used in the treatment of Susac syndrome and their risk categories established by the United States Food and Drug Administration.

Agent	Pregnancy category	Comments
Corticosteroids	C/D; C	Maternal and fetal risks include hyperglycemia, hypertension, and adrenal axis suppression; Fetal risk of cleft lip and low birth weight
Prednisone
Methylprednisolone
IVIg	C	Limited data. Crosses the placenta, and it is used to treat some neonatal conditions
Infliximab	Low-to-moderate risk [43]	Crosses the placenta. Report of agranulocytosis in infants [44]
Cyclophosphamide	D	If exposed in the first trimester, reports of skeletal malformations, leukopenia, anemia, pancytopenia, severe bone marrow hypoplasia, and gastroenteritis
Azathioprine	D	Reports of congenital anomalies, immunosuppression, lymphopenia, pancytopenia, and intrauterine growth retardation
Mycophenolate mofetil	D	Associated with congenital malformations and first-trimester pregnancy loss
Rituximab	C	Limited data available; transient B-cell lymphocytopenia
Plasmapheresis	Unknown	Potential maternal risk during plasmapheresis does not seem to increase as a result of pregnancy
Aspirin	D	Likely safer in low doses; Increased perinatal mortality, delayed closure of ductus arteriosus, and intrauterine growth retardation
Gadolinium (IV)	C	Crosses the placenta. May be an increased risk for rheumatological, inflammatory, or infiltrative skin conditions
Cyclosporine	C	May result in low birth weight and premature births
Methotrexate	X	Can cause teratogenic effects, embryotoxicity, abortion, and fetal defects. Contraindicated during pregnancy

A = controlled studies show no fetal risk. B = animal studies do not demonstrate risk. There is no evidence of risk in humans. C = animal studies show adverse reaction on the fetus, no studies in humans. D = positive evidence of human fetal risk. X = contraindicated in pregnancy.