ORIGINAL ARTICLE
Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider
Lisa A. Coscia,
Dorothy Kliniewski,
Serban Constantinescu,
Michael J. Moritz,
Corresponding Author
Lisa A. Coscia
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Correspondence
Lisa A. Coscia, Transplant Pregnancy Registry International, 401 N. 3 Street, Philadelphia, PA 19462, USA.
Email: [email protected]
Search for more papers by this authorDorothy Kliniewski
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Search for more papers by this authorSerban Constantinescu
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMichael J. Moritz
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Search for more papers by this authorLisa A. Coscia,
Dorothy Kliniewski,
Serban Constantinescu,
Michael J. Moritz,
Corresponding Author
Lisa A. Coscia
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Correspondence
Lisa A. Coscia, Transplant Pregnancy Registry International, 401 N. 3 Street, Philadelphia, PA 19462, USA.
Email: [email protected]
Search for more papers by this authorDorothy Kliniewski
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Search for more papers by this authorSerban Constantinescu
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMichael J. Moritz
Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
Search for more papers by this authorAbstract
Background
Healthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at-risk cohort.
Methods
This paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes.
Results
Overall pregnancy outcomes in recipients under the age of 21 are like the adult cohort.
Conclusion
It is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.
Open Research
DATA AVAILABILITY STATEMENT
Research data are not shared.
Supporting Information
| Filename | Description |
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| petr14752-sup-0001-FigureS1.pptxPowerPoint 2007 presentation , 2.5 MB |
Figure S1. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Fernandez HE, Foster BJ. Long-term care of the pediatric kidney transplant recipient. Clin J Am Soc Nephrol. 2022; 17(2): 296-304. doi:10.2215/CJN.16891020
- 2de la Calle M, Bartha JL, Lopez CM, et al. Younger age in adolescent pregnancies is associated with higher risk of adverse outcomes. Int J Environ Res Public Health. 2021; 18(16): 8514. doi:10.3390/ijerph18168514
- 3Isa F, Ryan H. Sexuality and reproductive health counseling in adolescent renal transplant recipients. Open Urol Nephrol J. 2014; 7: 144-151. doi:10.2174/1874303X014070100144
10.2174/1874303X014070100144 Google Scholar
- 4Wurm F, McKeaveney C, Corr M, Wilson A, Noble H. The psychosocial needs of adolescent and young adult kidney transplant recipients, and associated interventions: a scoping review. BMC Psychol. 2022; 10(1): 186. doi:10.1186/s40359-022-00893-7
- 5Ardura MI, Coscia LA, Meyers MR. Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant. 2021; 25(1):e13949. doi:10.1111/petr.13949
- 6Klein CL, Josephson MA. Post-transplant pregnancy and contraception. Clin J Am Soc Nephrol. 2022; 17(1): 114-120. doi:10.2215/CJN.14100820
- 7Al-Badri M, Kling JM, Vegunta S. Reproductive planning for women after solid-organ transplant. Cleve Clin J Med. 2017; 84(9): 719-728. doi:10.3949/ccjm.84a.16116
- 8Sarkar M, Bramham K, Moritz MJ, Coscia L. Reproductive health in women following abdominal organ transplant. Am J Transplant. 2018; 18(5): 1068-1076.
- 9Kittleson MM, DeFilippis EM, Bhagra CJ, et al. Reproductive health after thoracic transplantation: an ISHLT expert consensus statement. J Heart Lung Transplant. 2023; 42(3): e1-e42. doi:10.1016/j.healun.2022.10.009
- 10Sarkar M, Brady CW, Fleckenstein J, et al. Reproductive health and liver disease: practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021; 73(1): 318-365.
- 11French VA, Davis JS, Sayles HS, Wu SS. Contraception and fertility awareness among women with solid organ transplants. Obstet Gynecol. 2013; 122(4): 809-814.
- 12Abarca-Durán X, Fernández-Medina IM, Jiménez-Lasserrotte MDM, et al. Sexuality in kidney transplant recipients: a qualitative study. Healthcare. 2021; 9(11):1432. doi:10.3390/healthcare9111432
- 13Agarwal KA, Pavlakis M. Sexuality, contraception, and pregnancy in kidney transplantation. Kidney Med. 2021; 3(5): 837-847. doi:10.1016/j.xkme.2021.05.009
- 14Corr M, McKeaveney C, Wurm F, Courtney AE, Noble H. The educational needs of adolescent and young adult renal transplant recipients-a scoping review. Healthcare. 2023; 11(4): 566. doi:10.3390/healthcare11040566
- 15Ashoor IF, Dharnidharka VR. Sexually transmitted infection screening and reproductive health counseling in adolescent renal transplant recipients: perceptions and practice patterns. A study from the Midwest pediatric nephrology consortium. Pediatr Transplant. 2015; 19(7): 704-708. doi:10.1111/petr.12579
- 16Moritz MJ, Constantinescu S, Coscia LA, et al. Transplant pregnancy registry international (TPRI). 2022. Annual report. Philadelphia, PA: Gift of Life Institute; 2023:1–28.
- 17Shah S, Christianson AL, Bumb S, Verma P. Contraceptive use among women with kidney transplants in the United States. J Nephrol. 2022; 35(2): 629-638. doi:10.1007/s40620-021-01181-0
- 18Szymusik I, Szpotanska-Sikorska M, Mazanowska N, Ciszek M, Wielgos M, Pietrzak B. Contraception in women after organ transplantation. Transplant Proc. 2014; 46(10): 3268-3272. doi:10.1016/j.transproceed.2014.09.104
- 19Roe AH, Dutton C. Contraception for transplant patients. Transplantation. 2017; 101(8): 1739-1741. doi:10.1097/TP.0000000000001762
- 20Szpotanska-Sikorska M, Pietrzak B, Wielgos M. Contraceptive awareness and birth control selection in female kidney and liver transplant recipients. Contraception. 2014; 90(4): 435-439. doi:10.1016/j.contraception.2014.04.014
- 21Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR. 2016; 65(3): 1-103. doi:10.2307/24840638
- 22Xu L, Yang Y, Shi JG, et al. Unwanted pregnancy among Chinese renal transplant recipients. Eur J Contracept Reprod Health Care. 2011; 16(4): 270-276.
- 23ACOG Committee Opinion No. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2018; 131(5): e130-e139. doi:10.1097/AOG.0000000000002632
- 24Mantha S, Karp R, Raghavan V, Terrin N, Bauer KA, Zwicker JI. Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis. BMJ. 2012; 345:e4944. doi:10.1136/bmj.e4944
- 25Pietrzak B, Bobrowska K, Jabiry-Zieniewicz Z, et al. Oral and transdermal hormonal contraception in women after kidney transplantation. Transplant Proc. 2007; 39(9): 2759-2762. doi:10.1016/j.transproceed.2007.09.014
- 26Jabiry-Zieniewicz Z, Bobrowska K, Kaminski P, Wielgos M, Zieniewicz K, Krawczyk M. Low-dose hormonal contraception after liver transplantation. Transplant Proc. 2007; 39(5): 1530-1532.
- 27Armenti VT, Moritz MJ, Davison JM. Pregnancy following transplantation and immunosuppression: effects and outcome. Drug Saf. 1998; 19: 219-232.
- 28Armenti VT, Moritz MJ, Cardonick EH, Davison JM. Immunosuppression in pregnancy: choices for infant and maternal health. Drugs. 2002; 62(16): 2361-2375.
- 29Coscia LA, Constantinescu S, Davison JM, Moritz M, Armenti V. Immunosuppressive drugs and fetal outcome. Best Pract Res Clin Obstet Gynaecol. 2014; 28(8): 1174-1187.
- 30Coscia LA, Armenti DP, King RW, Sifontis NM, Constantinescu S, Moritz MJ. Update on the teratogenicity of maternal mycophenolate mofetil. J Pediatr Genet. 2015; 4(2): 42-55.
- 31Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in rheumatic and musculoskeletal diseases. Arthritis Care Res. 2020; 72(4): 461-488. doi:10.1002/acr.24130
10.1002/acr.24130 Google Scholar
- 32Park-Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000; 62(6): 385-392. doi:10.1002/1096-9926(200012)62:6<385::AID-TERA5>3.0.CO;2-Z
- 33Skuladottir H, Wilcox AJ, Ma C, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014; 100(6): 499-506. doi:10.1002/bdra.23248
- 34Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017; 43(3): 489-502. doi:10.1016/j.rdc.2017.04.013
- 35Hviid A, Mølgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ. 2011; 183(7): 796-804. doi:10.1503/cmaj.101063
- 36Perez-Aytes A, Marin-Reina P, Boso V, Ledo A, Carey JC, Vento M. Mycophenolate mofetil embryopathy: a newly recognized teratogenic syndrome. Eur J Med Genet. 2017; 60(1): 16-21. doi:10.1016/j.ejmg.2016.09.014
- 37Midtvedt K, Bergan S, Reisæter AV, Vikse BE, Åsberg A. Exposure to Mycophenolate and fatherhood. Transplantation. 2017; 101(7): e214-e217. doi:10.1097/TP.0000000000001747
- 38Chu SH, Liu KL, Chiang YJ, Wang HH, Lai PC. Sirolimus used during pregnancy in a living related renal transplant recipient: a case report. Transplant Proc. 2008; 40(7): 2446-2448.
- 39Framarino dei Malatesta M, Corona LE, De Luca L, et al. Successful pregnancy in a living-related kidney transplant recipient who received sirolimus throughout the whole gestation. Transplantation. 2011; 91(9): e69-e71.
- 40Fiocchi R, D'Elia E, Vittori C, et al. First report of a successful pregnancy in an everolimus-treated heart-transplanted patient: neonatal disappearance of immunosuppressive drugs. Am J Transplant. 2016; 16(4): 1319-1322.
- 41Coscia L, Cohen D, Dube GK, et al. Outcomes with Belatacept exposure during pregnancy in kidney transplant recipients: a case series. Transplantation. 2023; 107: 2047-2054. doi:10.1097/TP.0000000000004634
- 42McKay DB, Josephson MA, Armenti VT, et al. Women's health Committee of the American Society of transplantation. Reproduction and transplantation: report on the AST consensus conference on reproductive issues and transplantation. Am J Transplant. 2005; 5(7): 1592-1599. doi:10.1111/j.1600-6143.2005.00969.x
- 43Irani RA, Coscia LA, Chang E, Lappen JR. Society for Maternal-Fetal Medicine Consult Series #66: prepregnancy evaluation and pregnancy management of patients with solid organ transplants. Am J Obstet Gynecol. 2023; 229(2): B10-B32. doi:10.1016/j.ajog.2023.04.022
- 44Davison JM, Lind T, Uldall PR. Planned pregnancy in a renal transplant recipient. BJOG. 1976; 83: 518-527.
- 45Shah S, Venkatesan RL, Gupta A, et al. Pregnancy outcomes in women with kidney transplant: metaanalysis and systematic review. BMC Nephrol. 2019; 20(1): 24. doi:10.1186/s12882-019-1213-5
- 46Marson EJ, Kamarajah SK, Dyson JK, White SA. Pregnancy outcomes in women with liver transplants: systematic review and meta-analysis. HPB. 2020; 22(8): 1102-1111. doi:10.1016/j.hpb.2020.05.001
- 47Acuna S, Zaffar N, Dong S, Ross H, D'Souza R. Pregnancy outcomes in women with cardiothoracic transplants: a systematic review and meta-analysis. J Heart Lung Transplant. 2020; 39(2): 93-102. doi:10.1016/j.healun.2019.11.018
- 48Murray JE, Reid DE, Harrison JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med. 1963; 269: 341-343.
- 49Yin O, Kallapur A, Coscia L, Constantinescu S, Moritz M, Afshar Y. Differentiating acute rejection from preeclampsia after kidney transplantation. Obstet Gynecol. 2021; 137(6): 1023-1031. doi:10.1097/AOG.0000000000004389
- 50Bachmann F, Budde K, Gerland M, et al. Pregnancy following kidney transplantation – impact on mother and graft function and focus on childrens' longitudinal development. BMC Pregnancy Childbirth. 2019; 19(1): 376. doi:10.1186/s12884-019-2496-z
- 51Nulman I, Sgro M, Barrera M, Chitayat D, Cairney J, Koren G. Long-term neurodevelopment of children exposed in utero to Ciclosporin after maternal renal transplant. Paediatr Drugs. 2010; 12: 113-122.
- 52Dinelli MIS, Ono E, Viana PO, dos Santos AMN, de Moraes-Pinto MI. Growth of children born to renal transplanted women. Eur J Pediatr. 2017; 176(9): 1201-1207. doi:10.1007/s00431-017-2965-1
- 53Moritz MJ, Coscia LA, Armenti DP, Constantinescu S. National Transplantation Pregnancy Registry: cholestasis of pregnancy in liver transplant recipients. Am J Transplant. 2015; 15(S3):A#110.
- 54Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014; 124(1): 120-133. doi:10.1097/AOG.0000000000000346
- 55Wood AM, Livingston EG, Hughes BL, Kuller JA. Intrahepatic cholestasis of pregnancy: a review of diagnosis and management. Obstet Gynecol Surv. 2018; 73(2): 103-109. doi:10.1097/OGX.0000000000000524
- 56 Society for Maternal-Fetal Medicine (SMFM), Lee RH, Greenberg M, Metz TD, Pettker CM. Society for Maternal-Fetal Medicine Consult Series #53: intrahepatic cholestasis of pregnancy: replaces consult #13, April 2011. Am J Obstet Gynecol. 2021; 224(2): B2-B9. doi:10.1016/j.ajog.2020.11.002
- 57Hebert MF, Zheng S, Hays K, et al. Interpreting tacrolimus concentrations during pregnancy and postpartum. Transplantation. 2013; 95(7): 908-915. doi:10.1097/TP.0b013e318278d367
- 58 Low-dose aspirin use for the prevention of preeclampsia and related morbidity and mortality. 2021. Accessed February 22, 2022. https://www.acog.org/en/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality
- 59Duley L, Meher S, Hunter KE, Seidler AL, Askie LM. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2019; 2019:CD004659.
- 60Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017; 216: 110-120.e6.
- 61Stagno S, Pass RF, Cloud G, et al. Primary cytomegalovirus infection in pregnancy: incidence, transmission to fetus, and clinical outcome. JAMA. 1986; 256(14): 1904-1908.
- 62Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. N Engl J Med. 1992; 326(10): 663-667. doi:10.1056/nejm199203053261003
- 63Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017; 17(6): e177-e188. doi:10.1016/S1473-3099(17)30143-3
- 64Yin O, Kallapur A, Coscia L, et al. Mode of obstetric delivery in kidney and liver transplant recipients and associated maternal, neonatal, and graft morbidity during 5 decades of clinical practice. JAMA Netw Open. 2021; 4(10):e2127378. doi:10.1001/jamanetworkopen.2021.27378
- 65Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol. 2014; 28(8): 1163-1173.
- 66Thiagarajan K, Arakali SR, Mealey KJ, et al. Safety considerations: breastfeeding after transplant. Prog Transplant. 2013; 23: 137-146.
- 67Bramham K, Chusney G, Lee J, Lightstone L, Nelson-Piercy C. Breastfeeding and tacrolimus: serial monitoring in breast-fed and bottle-fed infants. Clin J Am Soc Nephrol. 2013; 8(4): 563-567. doi:10.2215/CJN.06400612
- 68Zheng S, Easterling TR, Hays K, et al. Tacrolimus placental transfer at delivery and neonatal exposure through breast milk. Br J Clin Pharmacol. 2013; 76(6): 988-996. doi:10.1111/bcp.12122
- 69 Drugs and Lactation Database (LactMed®). National Institute of Child Health and Human Development; 2006. https://www.ncbi.nlm.nih.gov/books/NBK501922/
- 70Zuber J, Anglicheau D, Elie C, et al. Sirolimus may reduce fertility in male renal transplant recipients. Am J Transplant. 2008; 8(7): 1471-1479. doi:10.1111/j.1600-6143.2008.02267.x
- 71Kaczmarek I, Groetzner J, Adamidis I, et al. Sirolimus impairs gonadal function in heart transplant recipients. Am J Transplant. 2004; 4(7): 1084-1088. doi:10.1111/j.1600-6143.2004.00456.x
