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Eculizumab Pregnancy Continuation aHUS — ESENeph MCQ

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HardPregnancy & RenalEculizumab Pregnancy Continuation aHUSESENeph

A 35-year-old woman with complement factor I deficiency develops aHUS post-partum. She achieves complete haematological and renal remission on eculizumab after 6 months. She is considering a second pregnancy. What specific counselling is needed regarding eculizumab in future pregnancies?

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Correct answer: D — Eculizumab can be continued through pregnancy but carries meningococcal risk requiring vaccination

Eculizumab is not teratogenic and can be continued through pregnancy in women with complement-mediated aHUS who are at high relapse risk. Pregnancy is a known trigger for aHUS relapse, particularly in patients with identified complement mutations. Key counselling points: (1) eculizumab crosses the placenta minimally but can affect neonatal complement levels; (2) meningococcal vaccination must be maintained (and antibiotic prophylaxis considered during pregnancy); (3) close monitoring with serial complement studies and haematological markers throughout pregnancy; (4) delivery planning with haematology, nephrology, and obstetrics. The decision to continue or restart eculizumab depends on the specific complement mutation and prior severity.

Reference: Servais et al 2016 – Eculizumab and Pregnancy aHUS; KDIGO 2025 – Complement Diseases