Pregnancy and Transplant - Risks and Complications

Introduction:

Most women experience no complications during pregnancy after transplantation. The function of the transplanted organ was healthy and stable before pregnancy. Even though pregnancy is considered safe after transplantation, it is very important to discuss with the health care professionals and take opinions regarding pregnancy. The following are the risks related to each organ:

• Kidney Transplant Recipients - Patients with increased blood pressure and creatinine levels before becoming pregnant may have more complications with the transplanted kidney.

• Heart Transplant Recipients - The workload on the heart will be more during the third trimester of pregnancy, so it is important to have proper heart function before pregnancy, to support the changes occurring during pregnancy.

• Liver Transplant Recipients - High blood pressure, gestational diabetes, increased bilirubin levels, pre-eclampsia, and rejection during pregnancy can be experienced in liver transplant patients during pregnancy.

• Lung Transplant Recipients - During pregnancy, lung transplant patients can experience a high risk, although the outcomes of this group have improved.

Is Pregnancy Possible After Transplantation?

Yes, pregnancy is possible after transplantation, but it is very important to discuss with the health care professionals before making any discussions regarding pregnancy. It is possible to become pregnant soon after transplantation, but there are increased risks associated with pregnancy. It is good to wait at least one year after the transplant to ensure that the organ is functioning well.

What Is the Risk of Transplantation During Pregnancy?

If the transplanted organ is functioning well, the risk for complications like miscarriage is the same as in normal people. But when the transplanted organ is not functioning well, it can lead to complications like:

• Miscarriage.

• Prematurity.

• Lower birth weights

• Poorly controlled blood pressure.

• Diabetes.

• Pre-eclampsia.

• Infection.

• Rejection of organs during the pregnancy.

The mothers are usually at greater risk of transplant rejection during pregnancy if the transplant does not work as normal. The lung transplant recipient experiences more rejection than any other solid organ recipient.

Are Babies of Transplant Recipients Healthy?

The babies of transplant recipients are normally born healthy and develop without any health complications, but in rare instances, health and developmental complications occur. The growth and development of these kids are monitored over time. If genetic or inherited conditions run in the family, the infant may be at risk of carrying or inheriting that condition. So it is very important to discuss any concerns with health professionals if there is a family history of a genetic problem and take genetic testing and counseling.

Are Anti-rejection Drugs Required During Pregnancy?

When planning for a pregnancy, it is important to take advice from the transplant teams on their immunosuppressive drugs and their potential benefits and risks to the transplantation and the fetus. Usually, immunosuppressive medications are safe as they do not show birth defects in babies. Prednisone, Calcineurin inhibitors, Cyclosporine, Azathioprine, and Tacrolimus, are safe medications during pregnancy.

The medical team may stop or replace some medications with others that will not affect the fetus. If a patient is taking a drug that is potentially harmful to the baby, the doctor may stop that drug and also ask that they not become pregnant for a while to make sure that the drug is completely out of the system. The goal of the doctors will be to maintain the health and function of the transplanted organ and prevent rejection during pregnancy while keeping the baby healthy.

What Nutritional Changes Have to Be Made During Pregnancy After the Transplant?

Maintaining a healthy and balanced diet during pregnancy after transplantation is important for the best pregnancy outcome. Some medicine can cause increased appetite, leading to weight gain. So it is necessary to monitor maternal nutrition and modify food habits during pregnancy to meet metabolic demands.

The amount of nutrients required during pregnancy is as follows,

• Carbohydrates - 45 to 65% of total calorie intake should be carbohydrates. It is advised to maximize complex carbohydrate intake and limit intake of simple carbohydrates.

• Fat - 20 to 35% of calories of fats should be taken during pregnancy, and trans fat intake should be minimized.

• Protein - The protein consumption should be slightly increased to 1 g/kg/day because, during pregnancy, the need for protein will increase.

• Fiber - An increase in fiber consumption is required, along with adequate fluid intake, to reduce the side effects of constipation associated with pregnancy.

• Folate - Intake of folate supplementation is recommended to prevent neural tube defects in the fetus.

• Potassium - Intake should be monitored because some transplant medications may cause hyperkalemia (potassium level in the blood that's higher than normal) as a side effect.

• Calcium - An intake of 1000 mg of calcium and ten micrograms of vitamin D is recommended for transplant recipients because most patients will be at an increased risk of developing osteopenia and osteoporosis, so following correct dietary intake can decrease bone loss and improve the risk of adverse outcomes.

What Are the Complications of Transplants During Pregnancy?

There are chances of complications during pregnancy, so the mother and the fetus will be monitored closely to identify and treat any complications as early as possible. So during prenatal visits, blood tests may be obtained more often to check for anemia. Urine tests will be done to check for protein and glucose. The weight and blood pressure will also be checked at each visit and examined for any signs of fluid retention or edema. The growth and development of the baby will be monitored through physical exams and ultrasounds.

Common complications that can occur during any pregnancy are:

• High blood pressure.

• Urinary tract infections (UTIs) is common during pregnancy. It is an infection caused by a lot of bacteria in the urine and is treated with oral antibiotics.

• Gestational diabetes occurs when there is an increase in blood glucose during pregnancy. This can happen due to the increased developmental need of the infant as well as the changes in the mother's hormones that affect how her insulin works. Even though blood glucose levels usually return to normal after delivery, the mothers are monitored closely so that any possible complications can be treated.

• Anemia is referred to as anemia when there is a decrease in hemoglobin (an oxygen-carrying substance found in red blood cells). Anemia can cause tiredness and weakness, and the skin may be pale. It can be corrected with iron supplements and a balanced diet.

• Pre-eclampsia is another possible pregnancy complication that causes high blood pressure, proteinuria, and edema of the feet.

• Proteinuria (presence of protein in the urine) can occur during pregnancy, especially with kidney disease. It is associated with fever.

Conclusion:

Successful pregnancy is always possible after all solid organ transplantation. However, transplant recipients are at high risk of developing complications in the mother and baby, so it is crucial to take advice from the transplant team and the gynecology department.