Caution with the use of cyclosporin in pregnancy

We read the article by Alstead and Nelson-Piercy with great interest.¹

We report a case (submitted for publication) of a woman with fulminant ulcerative colitis in the 29th week of pregnancy. Her disease was refractory to steroids, but she refused to have cyclosporin whilst pregnant. She therefore underwent an emergency Caesarean section and was given intravenous cyclosporin post-operatively. After 48 hours of treatment she developed severe hypertension with hypertensive encephalopathy and seizures. Although cyclosporin has been considered to be safe for both mother and foetus, we would like to highlight concerns that it is associated with potentially life threatening side effects. As a result, patients must be counselled thoroughly about the potential morbidity associated with this treatment and monitored closely. We agree with Dr Alstead in that cyclosporin should be used with extreme caution in pregnancy and the postnatal period.