Although IVIg is labeled pregnancy Category C, it is likely an excellent choice of therapy.

Pemphigus often affects women of child-bearing age. Treatment usually involves the use of powerful immunosuppressive drugs and high doses of systemic corticosteroids, such as prednisone. When a patient with pemphigus becomes pregnant or develops pemphigus during pregnancy, treatment becomes even more complicated. Intravenous immunoglobulin (IVIg) is an apparently good treatment option.


Investigators studied outcomes in eight patients with pemphigus vulgaris treated with IVIg during pregnancy. Four women had previously received IVIg. They had responded well, but disease recurred with pregnancy. Treatments with IVIg were given in cycles at 3- or 4-week intervals. Each patient received 2 g/kg/cycle given in three equal doses on 3 consecutive days, infused intravenously over 4 to 5 hours. The drug was generally well tolerated, although seven of the eight women developed headaches. All eight women had normal deliveries of healthy babies — in one case, healthy twins. No babies developed neonatal pemphigus. Pemphigus remitted in all patients, although it recurred in one of the four women who had successful subsequent pregnancies.


Citation(s):

Ahmed AR and Gürcan HM. Use of intravenous immunoglobulin therapy during pregnancy in patients with pemphigus vulgaris. J Eur Acad Dermatol Venereol 2011 Sep; 25:1073.