Esophageal atresia and prenatal exposure to mycophenolate

•Mycophenolate is a teratogenic drug. Its clinical pattern is still being delineated.•We present four cases with esophageal atresia prenatally exposed to mycophenolate.•Esophageal atresia could be a new feature even without major craniofacial anomalies.•Mycophenolate may reduce the efficacy of oral contraceptives. Mycophenolate mofetil is a widely prescribed immunosuppressive agent for transplant patients and autoimmune diseases. Potential teratogenic effects after in utero exposure to mycophenolate mofetil has been described in human clinical observations. The complete clinical pattern is still being delineated. We present four newborns with esophageal atresia and other congenital anomalies, prenatally exposed to mycophenolate mofetil during the first trimester. Two of the cases had other defects related to the embryopathy: microtia, eye abnormalities and oral clefts. Two cases did not show major craniofacial anomalies. We propose that esophageal atresia with or without tracheoesophageal fistula is a feature of mycophenolate embryopathy even without the presence of other major craniofacial anomalies. The human teratogenicity of MMF is reinforced by this report, and the current contraceptive recommendations about its use in fertile women are stressed.