Immunosuppression In Pregnancy

Abstract

For female solid organ transplant recipients of the childbearing age, restoration of normal health and fertility after transplantation creates an opportunity for them to become pregnant. Despite the first report of a successful pregnancy after kidney transplantationpublished over 50 years ago, there remains a paucity of data regarding the use of immunosuppression in this important patient population. Due to the risk of rejection, immunosuppression must be continued before, during, and after pregnancy. Apart from the teratogenicity concerns during pregnancy, normal physiological changes during pregnancy may alter the pharmacokinetic and pharmacodynamic profile of immunosuppressive agents. After pregnancy, there is further concern with the potential harmful effects of exposing the infant to immunosuppressive drugs with breast-feeding. Therefore, the common and easier recommendation for clinicians would be to avoid breastfeeding altogether, regardless of the safety profile of the individual immunosuppressive agents being taken. It is therefore imperative that transplant clinicians work closely with the obstetrics team, and are familiar with the optimal management of immunosuppression during pregnancy. The many concerns the patients will likely have needs to be adequately addressed, so that well-informed decisions regarding planning for pregnancy, management during pregnancy, and breastfeeding after pregnancy can be made.