Table 1

Pre-pregnancy treatment

Delay conception minimum 1 year (preferably 2 years) after transplant
Good general health and stable graft function (organ-specific assessment)
No recent episodes of acute rejection or evidence of ongoing chronic rejection
No recent episodes of infection or evidence of ongoing chronic infection (HIV, hepatitis B virus, hepatitis C virus, cytomegalovirus, herpes simplex virus, human papillomavirus, syphilis, rubella, varicella or toxoplasmosis)
Vaccinations should be given if needed (rubella, tetanus, hepatitis B virus, influenza and pneumococcus)
Normal blood pressure or mild arterial hypertension with minimal antihypertensive regimen (preferably only 1 drug; no angiotensin-converting enzyme inhibitors)
Acceptable renal function (creatinine level <1.5 mg⋅dL−1)
Absent or minimal proteinuria (<0.5 g⋅day−1)
Absent or adequately controlled diabetes mellitus
Immunosuppressive regimen including prednisone (<15 mg⋅day−1), azathioprine (<2 mg⋅kg−1⋅day−1), cyclosporine or tacrolimus (low therapeutic levels); mycophenolate mofetil, sirolimus and everolimus are contraindicated (and should be stopped 6 weeks before conception)
Contraception is needed until planned pregnancy
Aetiology of original disease and relevant genetic issues discussed
Risks of intrauterine growth restriction, prematurity and low birth weight discussed.
Risks of maternal complications (hypertension, pre-eclampsia, diabetes, graft rejection and graft loss) discussed
  • Reproduced and modified from [1] with permission from the publisher.