Rituximab targets the CD20 antigen expressed on B-lymphocytes and is used to treat recurrent minimal change disease, but experience of its use in pregnancy is limited. We describe a 28-year-old Caucasian female, with recurrent nephrotic syndrome secondary to minimal change disease. She had failed to respond to non-teratogenic alternative therapies. The patient was successfully maintained in remission with rituximab during two consecutive pregnancies. Rituximab (I g) was administered at I4+6 weeks 14 weeks and 6 days during Pregnancy I and 500 mg administered at 23~4 weeks 23 weeks and 4 days of Pregnancy 2. Rituximab had no apparent effect on infant B-cell development in either pregnancy, as neonatal lymphocyte titres were within normal range. There were no maternal complications in either pregnancy. Neither infant encountered infection-related complications. Although rituximab administration during pregnancy appeared safe, evidence of placental transfer is reported with neonatal B-cell depletion, thus alternatives with known safety profiles in pregnancy should be considered before rituximab administration.
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