Pregnancy after organ transplantation

Ovarian function with regular menstrual cycles is usually restored in women of reproductive age after solid organ transplantation. The number of pregnancies reported in these patients increases gradually. Pregnancy is always considered high risk, and not properly planned may lead to serious complications. The best for the patient is to conceive in a period of good general health and good stable graft function, after appropriate preparation and not later than five years after transplantation. Immunosuppressive regimen should be modified before conception. Sirolimus and mycophenolate mofetil should be excluded. The blood levels of immunosuppressive agents should be regularly controlled during the whole pregnancy. The rate of successful pregnancies is approximately 95% in graft recipients. Increased incidence of preterm labor, anemia and intrauterine growth restriction is observed compared with general population. Organ transplantation itself is not an indication for cesarean section and vaginal delivery is recommended as the best for the patient, the graft and the newborn. Breast feeding is believed to be contraindicated in women on immunosuppressive therapy, however no adverse effects were reported in children of graft recipients who decided to breast feed. The rate of congenital malformations in newborns is approximately 3-4% and does not differ from the rate seen in general population. The rate of perinatal deaths decreased beneath 0.8% in recent reports. Jaundice, hyperglycemia and hyperkalemia, observed more frequently in newborns of graft recipients, are mild and in most cases do not have any clinical implications.