Transplant and preg

Question 1

Outcomes for a woman who has had a transplant?

Answer 1

Delivered pre-term average 35 weeks
30% pre eclampsia
SGA babies
higher perinatal mortality

Question 2

Which meds have to be stopped pre preg?

Answer 2

MMF, sirolimus everolimus

ACE and ARB all trimesters BAD

Question 3

WHich meds are ok?

Answer 3

Tac/CycA, teroids, AZA (fetus lacks enzyme to activate to mercaptopurine)

All enter breast milk but can breast feed

Question 4

Post liver transplant, what is another thing to worry about?

Answer 4

Higher rates of rejection post partum

Question 5

Are outcomes as good for lupus women with well controlled disease?

Answer 5

No for some reason still worse.

Question 6

APL ab lab criteria- specifically

Answer 6

anticardioloipin IgG or M; med-high titre; 2 or more occasions 12 weeks apart

lupus anticoagulant on 2 or more occasiona 12 weeks apart

anti beta2 glycoprotein titre over 99th percentile; 2 or more occasions 12 weeks apart

Question 7

What to do with APL ladies getting preg?

Answer 7

If just antibodies; aspirin 70 or 100mg

If Ab plus thrombosis- LMWH plus aspirin

If recurrent preg loss, start aspirin before pregnant and LMWH in preg

Question 8

Hydroxychloroquine thought to be good or bad in APL and lupus preg?

Answer 8

Good, thought to have anti thrombotic effects

Safe

Question 9

MMF and methotrexate BREAST feeding?

Answer 9

No