Pregnancy in women with solid-organ transplants: A review

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. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing the activity, the learner should be better able to: identify potential maternal and neonatal complications in women undergoing pregnancy following solid-organ transplantation; explain the important preconceptual considerations for the female transplant recipient; identify potential fetal risk of immunosuppressive regimens and optimal therapy prior to conception; assess the relative compatibility of certain immunosuppressive medications with breast-feeding; recommend safe and effective contraception to the transplant recipient.