Jennifer K Durst1, Roxane M Rampersad2. 1. Fellow. 2. Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
Abstract
IMPORTANCE: Advances in solid-organ transplantation have allowed many women to reach reproductive potential, and pregnancy is no longer a rarity for these women. OBJECTIVE: To identify (1) potential complications to allograft function posed by pregnancy, (2) expected perinatal outcomes in women with solid-organ transplants, (3) risks of potential immunosuppressant regimens, (4) safety of lactation, and (5) contraceptive options for women with solid-organ transplants. EVIDENCE ACQUISITION: Single-center, registry data, and previous systematic reviews were evaluated in women with solid-organ transplants to identify the objectives of this review. In addition, recommendations from public health organizations were examined in regard to safety of medications and contraceptive methods. RESULTS: Women with solid-organ transplants are at risk for premature birth, low birth weight, cesarean delivery, and hypertensive disorders of pregnancy. Most immunosuppressant regimens are safe; however, mycophenolate mofetil should be avoided. Lactation with tacrolimus, cyclosporine, azathioprine, and prednisone appears safe. Long-acting reversible contraceptive methods are safe and effective for transplant recipients. CONCLUSIONS: Many successful pregnancies have been achieved in women following transplantation; however, optimal perinatal outcomes require stable allograft function. RELEVANCE: As more women are becoming pregnant after organ transplantation, a review of obstetric recommendations and perinatal outcome is warranted.
IMPORTANCE: Advances in solid-organ transplantation have allowed many women to reach reproductive potential, and pregnancy is no longer a rarity for these women. OBJECTIVE: To identify (1) potential complications to allograft function posed by pregnancy, (2) expected perinatal outcomes in women with solid-organ transplants, (3) risks of potential immunosuppressant regimens, (4) safety of lactation, and (5) contraceptive options for women with solid-organ transplants. EVIDENCE ACQUISITION: Single-center, registry data, and previous systematic reviews were evaluated in women with solid-organ transplants to identify the objectives of this review. In addition, recommendations from public health organizations were examined in regard to safety of medications and contraceptive methods. RESULTS:Women with solid-organ transplants are at risk for premature birth, low birth weight, cesarean delivery, and hypertensive disorders of pregnancy. Most immunosuppressant regimens are safe; however, mycophenolate mofetil should be avoided. Lactation with tacrolimus, cyclosporine, azathioprine, and prednisone appears safe. Long-acting reversible contraceptive methods are safe and effective for transplant recipients. CONCLUSIONS: Many successful pregnancies have been achieved in women following transplantation; however, optimal perinatal outcomes require stable allograft function. RELEVANCE: As more women are becoming pregnant after organ transplantation, a review of obstetric recommendations and perinatal outcome is warranted.
Authors: Jared S Fredrickson; Jason R Kolfenbach; Jennifer L Holmes; Jennifer N Cathcart; Anne M Lynch; Alan G Palestine Journal: Obstet Med Date: 2019-01-09