By Lisa A. Coscia, RN, BSN, Carolyn H. McGrory, MS, RN, and
Vincent T. Armenti, MD, PhD
The National Kidney Foundation encourages all transplant recipients who wish to grow their families to learn more about post-transplant pregnancies. Check out ten of the most frequently asked questions (FAQs) on the subject. The National Transplantation Pregnancy Registry (NTPR) studies pregnancy after organ transplantation and has provided information to the transplant community for over 20 years. To date, the NTPR has over 2,100 participants and some of these transplant recipients are even grandparents!
- Can I become pregnant after receiving a transplant?
Yes! After receiving a transplant your fertility can return quickly and you can become pregnant. You should use appropriate birth control measures and any consideration of pregnancy should be discussed with your healthcare providers.
- Is pregnancy safe after transplant?
Depending on the type of transplant you received and your other personal health factors, there may be special issues to consider. Although not very common, pregnancy may cause problems. Successful pregnancy is most likely when your transplanted organ is working well and your medication doses are stable prior to pregnancy.
- How long should I wait to become pregnant?
It makes sense to wait at least one year after your transplant to ensure that your medication regimen has stabilized and your transplanted organ is functioning as it should be. It is possible to become pregnant sooner, but the risks of pregnancy-related problems may be greater. You should speak with your healthcare team before you become pregnant.
- Do immunosuppressive medications need to be adjusted during pregnancy? Are there other drug levels that will need to be monitored?
It is very important to have close follow-up of your immunosuppressant drug levels during pregnancy. Your medications may have to be adjusted before and during your pregnancy. Whenever possible, it is recommended that you avoid taking CellCept®, Myfortic® and their generic forms (Mycophenolate Mofetil and Mycophenolic Acid) in the six weeks before becoming pregnant and throughout your pregnancy. Before you become pregnant, your physician may change your medications, so it's critical to speak with your healthcare team about your plans to grow your family. During your pregnancy, your immunosuppressive doses and some of your other medications may also be changed. Most transplant recipients are cared for by high-risk obstetricians. In a small number of cases, organ rejection has occurred during pregnancy.
- Do babies born to transplant recipients experience problems?
Compared to the general population, a female transplant recipient has about a three times greater chance of having a baby who is premature (born before 37 weeks) or low birth weight (weighing less than about five and one half pounds). The incidence of birth defects in the children is similar to that of the general population, except when a mother takes CellCept®, Myfortic® or their generic forms. With these drugs, there is both a higher chance the mother will miscarry and a higher chance that the baby will have birth defects. After a discussion with her transplant team, the transplant recipient taking these medications must weigh the risks and benefits of taking them during pregnancy. Women who are considering pregnancy while being maintained on newer therapies, such as sirolimus, everolimus and belatacept, should be aware that there is limited information currently available about the impact of these treatments on pregnancy.
- Can I breastfeed my infant?
The number of recipients who choose to breastfeed has increased over the years. Transplant recipients considering breastfeeding should consult with their healthcare team. Several recent studies have indicated that the benefits of breastfeeding outweigh the potential risks. Studies have shown that only a tiny amount of these medications is passed on to the infant through breast milk. No problems related to breastfeeding have been reported to the NTPR.
- Is it possible to have multiple pregnancies or carry more than one child?
Some women have reported more than one post-transplant pregnancy to the registry. As in first pregnancies, transplant recipients should have stable transplant function. A few recipients have even had successful twin and triplet pregnancies.
- Are there recipients who are at higher risk for complications during pregnancy?
Recipients with worsening graft function before pregnancy, such as kidney recipients with a creatinine greater than 2.5 mg/dL or liver recipients with recurrent hepatitis C, may be at an increased risk. Heart and lung recipients may have unique health considerations that could be affected by pregnancy. Pre-pregnancy counseling is especially advisable in these cases.
- What about pregnancies fathered by transplant recipients?
Fathering a pregnancy after transplant does not appear to cause problems, regardless of immunosuppressive regimen. Outcomes of pregnancies fathered by male recipients appear similar to the general population.
- Do the children develop normally?
The NTPR continually updates its information with a special focus on child health and development. At follow-up, the children are overwhelmingly reported to be healthy and developing well. Rare health or development problems have occurred, more likely due to prematurity or inherited disorders.
Every post-transplant pregnancy experience is important to the NTPR and healthcare providers and transplant recipients are encouraged to report all past or current pregnancies to the registry.
To receive more information or to register a pregnancy, please contact:
National Transplantation Pregnancy Registry (NTPR)