Solid organ transplantation in pregnancy

Key content In the UK, there are approximately 50-60 pregnancies in women with solid organ transplants each year. Kidney transplants are the most common. Adverse maternal and fetal outcomes, including rates of preeclampsia, fetal growth restriction and preterm delivery, are higher in women with solid organ transplants than in the general obstetric population. Management of the solid organ transplant recipient in pregnancy includes pre-eclampsia prophylaxis and monitoring, screening for gestational diabetes and fetal growth restriction, graft surveillance and management of immunosuppressive therapy. Multidisciplinary working is essential in the care of pregnant women with solid organ transplants. Vaginal birth is not contraindicated in women with solid organ transplants. Learning objectives To gain an overview of prepregnancy, antenatal, intrapartum and postpartum care required in women with kidney transplants. To understand how the management of pregnant women with pancreas, liver and cardiothoracic transplants compares with that of renal transplant recipients. To learn about medications used in women with solid organ transplants and their safety in pregnancy and lactation. Ethical issues The absence/paucity of safety data in pregnancy for some drugs used in solid organ transplant recipients. The lack of robust data comparing solid organ transplant recipients who have undergone a pregnancy with matched nulliparous controls in determining the impact of pregnancy on long-term graft outcome.