期刊
JOURNAL OF PERSONALIZED MEDICINE
卷 11, 期 10, 页码 -出版社
MDPI
DOI: 10.3390/jpm11100956
关键词
posttransplant pregnancy; fetotoxicity; eclampsia; immunosuppression
资金
- Franco Citterio, Department of Surgery, Kidney Transplantation, Catholic University, Rome, Italy [00168]
Pregnancy in kidney transplant women carries risks of maternal and fetal complications. Preconception counseling, maternal medical management, and proper drug use are crucial factors influencing the outcome of pregnancy in this population. Careful monitoring and medication adjustments are necessary to minimize potential fetotoxicity and adverse outcomes.
Pregnancy is not contraindicated in kidney transplant women but entails risks of maternal and fetal complications. Three main conditions can influence the outcome of pregnancy in transplant women: preconception counseling, maternal medical management, and correct use of drugs to prevent fetal toxicity. Preconception counseling is needed to prevent the risks of an unplanned untimely pregnancy. Pregnancy should be planned & GE;2 years after transplantation. The candidate for pregnancy should have normal blood pressure, stable serum creatinine < 1.5 mg/dL, and proteinuria < 500 mg/24 h. Maternal medical management is critical for early detection and treatment of complications such as hypertension, preeclampsia, thrombotic microangiopathy, graft dysfunction, gestational diabetes, and infection. These adverse outcomes are strongly related to the degree of kidney dysfunction. A major issue is represented by the potential fetotoxicity of drugs. Moderate doses of glucocorticoids, azathioprine, and mTOR inhibitors are relatively safe. Calcineurin inhibitors (CNIs) are not associated with teratogenicity but may increase the risk of low birth weight. Rituximab and eculizumab should be used in pregnancy only if the benefits outweigh the risk for the fetus. Renin-angiotensin system inhibitors, mycophenolate, bortezomib, and cyclophosphamide can lead to fetal toxicity and should not be prescribed to pregnant women.
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