*8.4.2 Mycophenolate mofetil*

Mycophenolate mofetil (MMF) is an inhibitor of purine biosynthesis, commonly used in LN, as both in induction and maintenance therapy, and is also used in severe to refractory non-renal manifestations, with the exception of neuropsychiatric lupus [60]. Due to its teratogenic effects, its use in pregnancy is contraindicated. MMF exposure can cause lip and cleft palate, abnormalities of distal limbs and malformations of multiple internal organs, such as heart, esophagus and kidneys [67]. For these reasons, it should be avoided. Alternative options are azathioprine, tacrolimus or low dose of glucocorticoids, which can be used to control disease activity. They should be started, ideally, 6 months prior conception.
