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Giving Birth Against the Odds

Women who have had organ transplants find they can bear children

SATURDAY, Feb. 8, 2003 (HealthDayNews) -- When Kim LaSalvia cradles her infant twin sons, she doesn't think of herself as a medical pioneer.

Perhaps she should.

"Pretty much up until recently, I didn't think I'd be able to have children," says LaSalvia, one of thousands of Americans who have received organ transplants -- in her case, a kidney. "I was diagnosed with lupus at 16 and between that and the transplant, I didn't think it would happen for me."

At one time, the medical community might have advised LaSalvia against becoming pregnant. Until recently, it was thought the anti-rejection drugs taken after transplant surgeries might harm a fetus, and the pregnancy itself might lead to problems with the transplanted organ.

"In a case like Kim's, the conventional wisdom would have been, she had a kidney transplant several years ago and it might cause problems," says Dr. Vincent Armenti, a transplant surgeon at Thomas Jefferson University Hospital in Philadelphia. "Not that it was discouraged, but there was a high level of concern and the issue was approached carefully."

Armenti is familiar with LaSalvia's case because she works as the kidney transplant coordinator at Jefferson. Also unique about her situation is that her husband, James, has been the recipient of three different kidneys in the past 10 years. They met on a blind date two years ago, and it wasn't until they decided to get married that LaSalvia started thinking about having children and began seeking information.

Her greatest resource was the National Transplant Pregnancy Registry (NTPR), which since 1991 has been recording pregnancy outcomes of transplant recipients (both mothers and fathers) in more than 200 centers across the United States. Although some records have been kept since 1958, this is a national database and the most comprehensive source available, with information on 1,300 pregnancy outcomes for women and about 2,000 people altogether. Kidney transplant patients make up the majority of patients in the registry.

"We still feel it's a higher risk situation, but we're encouraged by the results," says Armenti, director of the NTPR. "You have to have an assessment of risks for each patient instead of putting them all together. We're starting to look at each patient on a more individual basis."

Kidney transplant recipients are three times more likely to run into problems during their pregnancies than women in the general population. In pregnancies where the father is the organ recipient, the results are consistent with those in the general population.

Some of the most common problems observed in the female transplant recipients are high blood pressure and preeclampsia, which is a combination of high blood pressure, edema and protein in the urine. Preeclampsia affects about 7 percent of the general population during pregnancy and 25 percent to 35 percent of kidney transplant patients, says Armenti.

Infection is another problem for kidney patients, affecting about one quarter of the pregnancies. Most of these are minor, such as a urinary tract infection, but there can be an occasional serious infection that needs more aggressive treatment.

About 5 percent of kidney patients run into rejection problems during pregnancy, a number that is higher in those who have had pancreas transplants (8 percent) and liver transplants (5 percent to 10 percent).

It is recommended that female recipients wait at least two years after their operation to try to become pregnant, letting their bodies adjust to immunosuppressive medications, to make sure graft function is good and there's no sign of infection or rejection of the organ.

"These medical conditions are inherent problems in the transplant population, not just in those who are pregnant," Armenti says.

Other problems that have been identified through the NTPR are a higher incidence of prematurity in transplant recipients -- the average gestation period is 36 weeks, compared to 40 weeks for the general population -- and smaller birth weights. Cesarean section rates are higher as well because, Armenti says, "there is extra concern about these pregnancies, and many doctors don't want them to progress too far."

On the other hand, the database has shown no pattern for increases in birth defects, and the survival rate seems to be in line with the general population of premature babies. Once a pregnancy outcome is entered into the database, the child born to the transplant recipient is followed up to the age of 18. There have been no particular difficulties observed in these children.

"It's hard to find all the necessary information, so you have to make certain assumptions," Armenti says. "Further study needs to be made. This is an ongoing situation."

Kim LaSalvia says she's up every two hours during the night feeding her babies, born in November, and wouldn't have it any other way.

"I'm feeling really very grateful that everything worked out as well as it did," LaSalvia says. "The whole process wasn't without its risks, but if I had looked too much at those risks and chickened out, look what I would have missed out on. I still can't believe they're mine."

More information

Here's more on pregnancy and transplants. You can also check out the latest research on the risks of pregnancy among transplant recipients.

SOURCES: Vincent Armenti, M.D., transplant surgeon, and Kim LaSalvia, kidney transplant coordinator, both at Thomas Jefferson University Hospital, Philadelphia
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