Table 4.

Summary of Obstetric Management for Pregnancy After Transplantation

After Transplantation Delay conception for at least 1 year with adequate contraception Assess and monitor graft function Maintain immunosuppressive regimen Manage comorbid conditions

Preconception Counseling Discuss the effect of pregnancy on transplant organ function Discuss risks of maternal complications: hypertension, preeclampsia, diabetes, rejection, and graft loss Obtain good control of prepregnancy hypertension and diabetes Discuss risks of neonatal complications: prematurity and low birth weight Modification of immunosuppressive regimen if necessary Test for cytomegalovirus and other potential infections

Early Pregnancy Accurate and early diagnosis and dating of pregnancy Close monitoring of graft function and immunosuppressive drug levels Surveillance for bacterial infection [urine culture and viral infection (cytomegalovirus and herpes simplex virus)] Fetal surveillance for malformation, fetal growth, and well-being Maternal surveillance for hypertension, gestational diabetes, and preeclampsia Anesthesia evaluation/consult for heart/lung transplant patients

Labor and Delivery Aim to deliver at term Perform cesarean delivery only for appropriate obstetric reasons For heart, lung, and heart-lung recipients: continuous cardiac monitoring, judicious use of intravenous fluids, early involvement with anesthesiology

Postpartum Monitor immunosuppressive drug levels and alter doses and regimen as necessary Begin contraception when appropriate The documented benefits of breastfeeding may outweigh the potential risks of infant immunosuppressive exposure Mental health counseling if needed for postpartum depression

Data from Mastrobattista and Gomez-Lobo¹⁵ and Armenti VT et al.¹⁷