Maternal, foetal and child consequences of immunosuppressive drugs during pregnancy in women with organ transplant: a review

Abstract

Although pregnancy remains exceptional in women after heart, liver or lung transplant, obstetricians and nephrologists are regularly confronted with pregnancy in renal transplant recipients. National and international registries described the epidemiology of maternal, foetal and neonatal complications, and transplantation societies published recommendations on the monitoring of these high-risk pregnancies. In this review, we summarize the existing data on maternal and foetal complications of pregnancies in women after renal transplant, especially the management of immunosuppression. We also describe the few available data on the middle- and long-term outcome of their children who were exposed in utero to immunosuppressive drugs.

Maternal, Decidual, and Neonatal Lymphocyte Composition Is Affected in Pregnant Kidney Transplant Recipients

“…The longitudinal assessment of neonatal immunity in children born from women with a kidney transplant is an important consideration in order to fully understand long term effects of in utero exposure. Unfortunately, only few studies exist that indicate that immune changes can persist up to 1 year after birth (22,62,63,68). Overall, the impaired neonatal innate and adaptive immune system at birth observed here underscores that children born to kidney transplant recipients could be at an increased risk for developing health complications early and later in life.…”

Determinants of Perinatal Outcomes in Dialyzed and Transplanted Women in Australia

“…Pregnancy-induced hypertension is an important determinant of perinatal outcomes, reflecting placental dysfunction likely driven by risk factors such as pre-existing obesity, hypertension, and diabetes, 30 which are more frequent in women with kidney failure. Furthermore, chronic vascular damage from uremia and hypertension, kidney impairment, and immunosuppression exposure 31 , 32 , 33 , 34 , 35 will contribute to further placental dysfunction in transplanted women. Pre-eclampsia and pregnancy-related hypertension rates in transplanted women are high.…”

A 25-Year-Old Saudi Woman with a 2-Year History of Antisynthetase Syndrome with Interstitial Lung Disease Who Commenced Azathioprine Treatment in the Third Trimester of Pregnancy and Had a Successful Birth at Term

“…For treatment in pregnancy, corticosteroids, azathioprine, and cyclosporine are safely used in pregnant women with systemic lupus erythematosus [ 25 – 27 ]; cyclophosphamide is contraindicated due to the increased risk of miscarriage and congenital anomalies [ 25 – 27 ]; and because data on rituximab are limited, rituximab discontinuation before conception is advised [ 25 – 27 ]. Tacrolimus and cyclosporine are safe options for pregnant women after organ transplantation; however, mycophenolate mofetil is contraindicated, as it is associated with a high risk of miscarriage and congenital anomalies and must be discontinued 3–6 months before pregnancy [ 28 , 29 ]. As the course of ASS is unknown, a multidisciplinary approach is advised, particularly if severe manifestations such as pulmonary hypertension or severe ILD develop to alter the treatment and timing of delivery.…”