Dr Monique Kowitz1, Dr Ann-Maree Craven1, Dr Karin Lust1,2, Dr Renuka Sekar3, Dr Penny Wolski1, Dr Leonie Callaway1,2
1Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia, 2School of Medicine, University of Queensland, Brisbane, Australia, 3Department of Maternal and Fetal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
Biography:
Dr Monique Kowitz is an Obstetric Medicine and General Medicine Advanced Trainee. She is fascinated by the complex interplay between medical disorders and pregnancy, and is passionate about improving the outcomes and experiences of women and their families during a time that is meant to be momentous and special.
Abstract:
Background: Pregnancies in women with solid organ transplants are increasing. Pre-conception comorbidities, an inherent risk of rejection and graft loss, immunosuppression, and higher rates of maternal and fetal complications make managing these pregnancies challenging.
This study aims to evaluate the management and outcomes of pregnancies in women with solid organ transplants at a large tertiary public hospital in Australia compared to current clinical practice guidelines and outcome data.
Method: A retrospective analysis of all pregnancies in solid organ transplant recipients (including heart, lung, liver and kidney transplants) at the Royal Brisbane and Women’s Hospital over a 15-year period from 2009 to 2023 was performed.
Baseline maternal demographics, maternal and fetal outcomes, and processes of clinical care were recorded.
Results: There were 34 pregnancies in 25 women with solid organ transplants.
85.3% resulted in live births. There were 2 terminations of pregnancy, 3 miscarriages and no stillbirths. Among the pregnancies resulting in a live birth, 41.4% were complicated by pre-eclampsia, 6.9% were complicated by gestational diabetes mellitus and 72.4% of women delivered via caesarean section.
There were two cases of rejection during pregnancy in a liver transplant recipient and lung transplant recipient. There were two cases of graft failure during pregnancy or post-partum in two kidney transplant recipients. There was one maternal death secondary to infection following termination of pregnancy in a liver transplant recipient.
75.9% of babies were born prematurely with 10.3% extremely preterm, 64.5% had a low birth weight, 9.7% were small for gestational age and 87.1% were admitted to the special care nursery or neonatal intensive care unit.
Conclusion: Whilst live births post solid organ transplantation are possible, the rate of maternal and fetal complications remains high. This emphasises the importance of individualised preconception care prior to pregnancy, and fastidious monitoring of both mother and baby during pregnancy.
Keywords
pregnancy, transplant