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Boulay H, Mazaud-Guittot S, Supervielle J, Chemouny JM, Dardier V, Lacroix A, Dion L, Vigneau C. Maternal, foetal and child consequences of immunosuppressive drugs during pregnancy in women with organ transplant: a review. Clin Kidney J 2021; 14:1871-1878. [PMID: 34345409 PMCID: PMC8323135 DOI: 10.1093/ckj/sfab049] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Although pregnancy remains exceptional in women after heart, liver or lung transplant, obstetricians and nephrologists are regularly confronted with pregnancy in renal transplant recipients. National and international registries have described the epidemiology of maternal, foetal and neonatal complications, and transplantation societies have published recommendations on the monitoring of these high-risk pregnancies. In this review, we summarize the existing data on maternal and foetal complications of pregnancies in women after renal transplant, especially the management of immunosuppression. We also describe the few available data on the middle- and long-term outcomes of their children who were exposed in utero to immunosuppressive drugs.
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Affiliation(s)
- Hugoline Boulay
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Séverine Mazaud-Guittot
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Jeanne Supervielle
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Jonathan M Chemouny
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Virginie Dardier
- Laboratoire de psychologie, comportement, cognition et communication (LP3 C), Université Rennes-Rennes 2, Rennes, France
| | - Agnes Lacroix
- Laboratoire de psychologie, comportement, cognition et communication (LP3 C), Université Rennes-Rennes 2, Rennes, France
| | - Ludivine Dion
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
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Vani JM, de Carvalho Schweich L, de Oliveira KRW, Auharek SA, Cunha-Laura AL, Antoniolli-Silva ACMB, Nazario CED, Oliveira RJ. Evaluation of the effects of the larvicides temephos on reproductive performance, embryofetal development and DNA integrity of Swiss mice. PESTICIDE BIOCHEMISTRY AND PHYSIOLOGY 2018; 148:22-27. [PMID: 29891373 DOI: 10.1016/j.pestbp.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 03/05/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
Temephos is considered the gold standard by the Ministry of Health for controlling the larvae of the mosquito Aedes aegypti. The present study evaluated the effects of Temephos larvicide on the reproductive performance, embryo-fetal development and DNA integrity of Swiss mice. This study used 30 pregnant female mice: 10 were controls treated with drinking water at a dosage of 0.1 mL/10 g (body weight - b.w., administered orally - a.o.), and 20 were treated with Temephos at doses of 0.0043 mg/kg and 0.043 mg/kg (b.w., a.o.) during the gestational period. Statistical analysis showed that Temephos did not alter the biometric or reproductive parameters. Comparing the weight of the fetus to the stage of pregnancy demonstrated that the 0.0043 mg/kg dosage increased the size of the fetuses. No external malformations were detected. However, the 0.043 mg/kg dosage induced changes in the sternum, with the main change being the center of the sternum, xiphoid processes and absence of the manubrium. The other skeletal and visceral alterations did not differ from the control group and are considered variants of normality. The analysis of head measurements showed an increase in the anterior/posterior measurements of the glabella, the external occipital protuberance and the biauricular plane. The circumference and area of the head did not present significant differences. The micronucleus test showed only a 0.043 mg/kg increase in 48 h. Thus, it is considered that Temephos has a low teratogenic and genotoxic risk.
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Affiliation(s)
- Juliana Miron Vani
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica - CeTroGen, Hospital Universitário Maria Aparecida Pedrossian - HUMAP, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil; Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina "Dr. Hélio Mandetta" - FAMED, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
| | - Laynna de Carvalho Schweich
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica - CeTroGen, Hospital Universitário Maria Aparecida Pedrossian - HUMAP, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil; Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina "Dr. Hélio Mandetta" - FAMED, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
| | - Karla Regina Warszawski de Oliveira
- Programa de Pós-graduação em Química - INQUI, Universidade Federal de Mato Grosso do Sul- UFMS, Campo Grande, MS, Brazil; Laboratório de Combustiveis - LABCOM, Instituto de Química - INQUI, Universidade Federal de Mato Grosso do Sul- UFMS, Campo Grande, MS, Brazil
| | - Sarah Alves Auharek
- Faculdade de Medicina do Mucuri, Universidade Federal dos Vales do Jequitinhonha e do Mucuri - UFVJM, Teófilo Otoni, MG, Brazil
| | - Andréa Luiza Cunha-Laura
- Programa de Mestrado em Farmácia, Instituto de Biociências - INBIO, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
| | - Andréia Conceição Millan Brochado Antoniolli-Silva
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica - CeTroGen, Hospital Universitário Maria Aparecida Pedrossian - HUMAP, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil; Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina "Dr. Hélio Mandetta" - FAMED, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
| | - Carlos Eduardo Domingues Nazario
- Programa de Pós-graduação em Química - INQUI, Universidade Federal de Mato Grosso do Sul- UFMS, Campo Grande, MS, Brazil; Laboratório de Combustiveis - LABCOM, Instituto de Química - INQUI, Universidade Federal de Mato Grosso do Sul- UFMS, Campo Grande, MS, Brazil
| | - Rodrigo Juliano Oliveira
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica - CeTroGen, Hospital Universitário Maria Aparecida Pedrossian - HUMAP, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil; Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina "Dr. Hélio Mandetta" - FAMED, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil; Programa de Pós-graduação em Genética e Biologia Molecular, Centro de Ciências Biológicas - CCB, Universidade Estadual de Londrina, Londrina, PR, Brazil.
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Vani JM, Monreal MTFD, Auharek SA, Cunha-Laura AL, de Arruda EJ, Lima AR, da Silva CM, Antoniolli-Silva ACMB, de Lima DP, Beatriz A, Oliveira RJ. The mixture of cashew nut shell liquid and castor oil results in an efficient larvicide against Aedes aegypti that does not alter embryo-fetal development, reproductive performance or DNA integrity. PLoS One 2018; 13:e0193509. [PMID: 29554095 PMCID: PMC5858748 DOI: 10.1371/journal.pone.0193509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
Dengue fever, chikungunya fever and Zika virus are epidemics in Brazil that are transmitted by mosquitoes, such as Aedes aegypti or Aedes albopictus. The liquid from shells of cashew nuts is attractive for its important biological and therapeutic activities, which include toxicity to mosquitoes of the genus Aedes. The present study evaluated the effects of a mixture of surfactants from natural cashew nutshell liquid and castor oil (named TaLCC-20) on the mortality of larvae and on the reproductive performance, embryonic and fetal development and genetic stability of Swiss mice. A total of 400 Ae. aegypti larvae (third larval stage) were treated with TaLCC-20 concentrations of 0.05 mg/L, 0.5 mg/L, or 5 mg/L (ppm). Twenty pregnant female mice were also orally administered TaLCC-20 at doses of 5 mg/kg and 50 mg/kg body weight (b.w.), and 10 animals were given only drinking water at 0.1 mL/10 g b.w. (orally). The results of a larvicide test demonstrated that 5 mg/mL TaLCC-20 killed 100% of larvae within three hours, which is comparable to the gold standard indicated by the Ministry of Health. Overall, these results show that TaLCC-20 is an efficient larvicide that does not induce genetic damage. In addition, changes in reproductive performance and embryo-fetal development appear positive, and the formulation is cost effective. Therefore, TaLCC-20 is an important product in the exploration of natural larvicides and can assist in fighting mosquitos as vectors for dengue fever, chikungunya fever and Zika virus, which are emerging/re-emerging and require proper management to ensure minimal harm to the human population. Therefore, TaLCC-20 can be considered a key alternative to commercial products, which are effective yet toxigenic.
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Affiliation(s)
- Juliana Miron Vani
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica—CeTroGen, Hospital Universitário Maria Aparecida Pedrossian–HUMAP, Universidade Federal de Mato Grosso do Sul—UFMS, Campo Grande, MS, Brasil
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina “Dr. Hélio Mandetta”–FAMED, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
| | - Maria Tereza Ferreira Duenhas Monreal
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
| | - Sarah Alves Auharek
- Faculdade de Medicina do Mucuri, Universidade Federal dos Vales do Jequitinhonha e do Mucuri–UFVJM, Teófilo Otoni, MG, Brasil
| | - Andréa Luiza Cunha-Laura
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
| | - Eduardo José de Arruda
- Faculdade de Ciências Exatas e Tecnologia–FACET, Universidade Federal da Grande Dourados–UFGD, Dourados, MS, Brasil
| | - Alessandra Ramos Lima
- Faculdade de Ciências Exatas e Tecnologia–FACET, Universidade Federal da Grande Dourados–UFGD, Dourados, MS, Brasil
| | - Cicera Maria da Silva
- Faculdade de Ciências Exatas e Tecnologia–FACET, Universidade Federal da Grande Dourados–UFGD, Dourados, MS, Brasil
| | - Andréia Conceição Milan Brochado Antoniolli-Silva
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica—CeTroGen, Hospital Universitário Maria Aparecida Pedrossian–HUMAP, Universidade Federal de Mato Grosso do Sul—UFMS, Campo Grande, MS, Brasil
- Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina “Dr. Hélio Mandetta”–FAMED, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
| | - Dênis Pires de Lima
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- Instituto de Química—INQUI, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
| | - Adilson Beatriz
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- Instituto de Química—INQUI, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- * E-mail: (AB); (RJO)
| | - Rodrigo Juliano Oliveira
- Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica—CeTroGen, Hospital Universitário Maria Aparecida Pedrossian–HUMAP, Universidade Federal de Mato Grosso do Sul—UFMS, Campo Grande, MS, Brasil
- Programa de Mestrado em Farmácia, Faculdade de Ciências Farmacêuticas Alimentos e Nutrição—FACFAN, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- Programa de Pós-graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina “Dr. Hélio Mandetta”–FAMED, Universidade Federal de Mato Grosso do Sul–UFMS, Campo Grande, MS, Brasil
- Programa de Pós-graduação em Genética e Biologia Molecular, Centro de Ciências Biológicas–CCB, Universidade Estadual de Londrina, Londrina, PR, Brasil
- * E-mail: (AB); (RJO)
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Kociszewska-Najman B, Mazanowska N, Pietrzak B, Paczek L, Szpotanska-Sikorska M, Schreiber-Zamora J, Hryniewiecka E, Zochowska D, Samborowska E, Dadlez M, Wielgos M. Low Transfer of Tacrolimus and Its Metabolites into Colostrum of Graft Recipient Mothers. Nutrients 2018; 10:E267. [PMID: 29495430 PMCID: PMC5872685 DOI: 10.3390/nu10030267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/18/2018] [Accepted: 02/22/2018] [Indexed: 12/29/2022] Open
Abstract
Currently, the majority of neonates born to organ recipient mothers on chronic immunosuppressive therapy are formula fed. However, over the past few years, evidence has grown, suggesting that breastfeeding might be possible and beneficial. We designed a study assessing the transfer of tacrolimus into the colostrum of posttransplant mothers. We assessed the amount of tacrolimus and its metabolites, M-1 and M-3, that would be ingested by the breastfed neonates. Concentrations of tacrolimus and its metabolites were measured in colostrum from 14 posttransplant mothers as well as in venous cord blood and venous blood of the neonates. Test material analysis was performed by liquid chromatography coupled with mass spectrometry (LC/MS). The amount of ingested formula was registered, which allowed for estimation of the amount of tacrolimus and its metabolites that would be ingested by breastfed infants. The mean amount of tacrolimus that would be ingested by the neonates in maternal milk was 151.4 ng/kg/24 h (standard deviation SD ± 74.39); metabolite M-1: 23.80 ng/kg/24 h (SD ± 14.53); and metabolite M-3: 13.25 ng/kg/24 h (SD ± 9.05). The peak level of tacrolimus and metabolite M-1 in colostrum was noted 8 h after an oral dose (3.219 ng/mL SD ± 2.22 and 0.56 ng/mL SD ± 0.60, respectively) and metabolite M-3 after 6 h (0.29 ng/mL SD ± 0.22). Low concentrations of tacrolimus and its metabolites, M-1 and M-3, in colostrum show that neonates will ingest trace amounts of the drug. Further studies are required to fully assess the safety of breastfeeding by posttransplant mothers.
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Affiliation(s)
| | - Natalia Mazanowska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Bronislawa Pietrzak
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Leszek Paczek
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, 00-001 Warsaw, Poland.
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland.
| | | | - Joanna Schreiber-Zamora
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Ewa Hryniewiecka
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, 00-001 Warsaw, Poland.
| | - Dorota Zochowska
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, 00-001 Warsaw, Poland.
| | - Emilia Samborowska
- Mass Spectrometry Laboratory, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland.
| | - Michal Dadlez
- Mass Spectrometry Laboratory, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland.
- Institute of Genetics and Biotechnology, Biology Department, Warsaw University, 02-096 Warsaw, Poland.
| | - Miroslaw Wielgos
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
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Kociszewska-Najman B, Pietrzak B, Czaplinska N, Cyganek A, Jabiry-Zieniewicz Z, Schreiber-Zamora J, Drozdowska-Szymczak A, Bobrowska K, Wielgos M. Congenital Infections in Neonates of Women With Liver or Kidney Transplants. Transplant Proc 2016; 48:1556-60. [DOI: 10.1016/j.transproceed.2016.01.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
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Abstract
Pregnancy associated liver diseases affect up to 3% of pregnant women and are the most frequent cause of liver dysfunction in pregnancy. When severe, they are associated with significant morbidity and mortality for both mother and infant. A rapid evaluation to distinguish them from non-pregnancy related liver dysfunction is essential, in order to facilitate appropriate management. Liver disease unrelated to pregnancy can present de novo in pregnancy, or pregnancy can occur in women with preexisting liver pathology (Table 1). Research and subsequent advances in medical care have resulted in improved but still not satisfactory maternal and fetal outcomes. In this review we provide an overview of the liver diseases specific to the pregnant state and an update on their pathogenesis, treatment and outcomes. The risks of pregnancy in women with pre-existent liver pathology is detailed and recent advances in our understanding of specific risks and outcomes are discussed.
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Rafie S, Lai S, Garcia JE, Mody SK. Contraceptive use in female recipients of a solid-organ transplant. Prog Transplant 2014; 24:344-8. [PMID: 25488557 PMCID: PMC4849405 DOI: 10.7182/pit2014426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Women of reproductive age account for more than one-third of all solid-organ transplant recipients and are advised against becoming pregnant for 1 to 2 years after their surgeries. The risks posed to the woman, the transplanted organ, and the fetus underscore the importance of systems to ensure that patients receive counseling on family planning, including return to fertility, contraceptive use, and when pregnancy can be safely considered, and highly effective methods of contraception. OBJECTIVE To investigate use of contraceptives among women after solid-organ transplant and to identify opportunities to improve care. DESIGN A cross-sectional survey study. SETTING An urban academic medical center. PATIENTS Women 18 to 50 years old who have received a kidney, pancreas, and/or liver transplant within the past 1 to 24 months. INTERVENTION Participants completed self-administered questionnaires regarding their menstrual pattern, pregnancy history, contraceptive use before and after transplant, and counseling on family planning issues. MAIN OUTCOME MEASURES Contraceptive use. RESULTS The most common contraceptive method used in both the year preceding transplant and the year after transplant was condoms. Participants desired more counseling on highly effective contraceptive methods, such as intrauterine devices. Participants would like to receive contraceptive counseling from an obstetrician/gynecologist or transplant care team provider. CONCLUSION Female recipients of solid-organ transplants want more counseling on highly effective methods of contraception.
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Zheng S, Easterling TR, Hays K, Umans JG, Miodovnik M, Clark S, Calamia JC, Thummel KE, Shen DD, Davis CL, Hebert MF. Tacrolimus placental transfer at delivery and neonatal exposure through breast milk. Br J Clin Pharmacol 2014; 76:988-96. [PMID: 23528073 DOI: 10.1111/bcp.12122] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/10/2013] [Indexed: 01/16/2023] Open
Abstract
AIM(S) The current investigation aims to provide new insights into fetal exposure to tacrolimus in utero by evaluating maternal and umbilical cord blood (venous and arterial), plasma and unbound concentrations at delivery. This study also presents a case report of tacrolimus excretion via breast milk. METHODS Maternal and umbilical cord (venous and arterial) samples were obtained at delivery from eight solid organ allograft recipients to measure tacrolimus and metabolite bound and unbound concentrations in blood and plasma. Tacrolimus pharmacokinetics in breast milk were assessed in one subject. RESULTS Mean (±SD) tacrolimus concentrations at the time of delivery in umbilical cord venous blood (6.6 ± 1.8 ng ml(-1)) were 71 ± 18% (range 45-99%) of maternal concentrations (9.0 ± 3.4 ng ml(-1)). The mean umbilical cord venous plasma (0.09 ± 0.04 ng ml(-1)) and unbound drug concentrations (0.003 ± 0.001 ng ml(-1)) were approximately one fifth of the respective maternal concentrations. Arterial umbilical cord blood concentrations of tacrolimus were 100 ± 12% of umbilical venous concentrations. In addition, infant exposure to tacrolimus through the breast milk was less than 0.3% of the mother's weight-adjusted dose. CONCLUSIONS Differences between maternal and umbilical cord tacrolimus concentrations may be explained in part by placental P-gp function, greater red blood cell partitioning and higher haematocrit levels in venous cord blood. The neonatal drug exposure to tacrolimus via breast milk is very low and likely does not represent a health risk to the breastfeeding infant.
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Affiliation(s)
- Songmao Zheng
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
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Abstract
Kidney disease and pregnancy may exist in two general settings: acute kidney injury that develops during pregnancy, and chronic kidney disease that predates conception. In the first trimester of pregnancy, acute kidney injury is most often the result of hyperemesis gravidarum, ectopic pregnancy, or miscarriage. In the second and third trimesters, the common causes of acute kidney injury are severe preeclampsia, hemolysis-elevated liver enzymes-low platelets syndrome, acute fatty liver of pregnancy, and thrombotic microangiopathies, which may pose diagnostic challenges to the clinician. Cortical necrosis and obstructive uropathy are other conditions that may lead to acute kidney injury in these trimesters. Early recognition of these disorders is essential to timely treatment that can improve both maternal and fetal outcomes. In women with preexisting kidney disease, pregnancy-related outcomes depend upon the degree of renal impairment, the amount of proteinuria, and the severity of hypertension. Neonatal and maternal outcomes in pregnancies among renal transplant patients are generally good if the mother has normal baseline allograft function. Common renally active drugs and immunosuppressant medications must be prescribed, with special considerations in pregnant patients.
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Richman K, Gohh R. Pregnancy after renal transplantation: a review of registry and single-center practices and outcomes. Nephrol Dial Transplant 2012; 27:3428-34. [PMID: 22815546 DOI: 10.1093/ndt/gfs276] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Registries from North America, Australia and Europe are rich sources of clinical data on pregnancy after kidney transplantation. Single-center reports of pregnancy outcomes are limited by small sample sizes but not by the potential reporting bias that can impact registry data. Despite the differences in data pools, the obstetric and graft outcomes reported by single centers and registries have been similar. The majority of pregnancies are successful in renal transplant patients, but the risk of complications like pre-eclampsia, low birth weight and premature birth is high. Pregnancy has no significant impact on graft function or survival when baseline function is normal.
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Westbrook RH, Yeoman AD, Kriese S, Heneghan MA. Outcomes of pregnancy in women with autoimmune hepatitis. J Autoimmun 2012; 38:J239-44. [PMID: 22261501 DOI: 10.1016/j.jaut.2011.12.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/04/2011] [Accepted: 12/05/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Optimal management during pregnancy of patients with autoimmune hepatitis (AIH) remains undefined. We therefore reviewed all patients with AIH who reported pregnancy at our centre to identify any pre-conception factors that might predict adverse outcomes. RESULTS There were 81 pregnancies in 53 women. Median age at conception was 26 years (range 16-42); with 41% of pregnancies occurring in the context of cirrhosis. At conception, 61 patients (75%) were on therapy for AIH. The live birth rate (LBR) was 73% (59/81). Prematurity, occurred in 12/59 (20%) and 6 (11%) required admission to special care baby unit (SCBU). In mothers who were cirrhotic at the time of conception the LBR was lower (p = 0.02) and need for admission to SCBU was higher. The overall maternal complication rate was 31/81 (38%) conceptions. A flare in disease activity occurred in 26/81 (33%) pregnancies. A serious maternal adverse event (death or need for liver transplant) during or within 12-months of delivery, or hepatic decompensation during or within 3-months of delivery, occurred with 9 pregnancies (11%) and was more common in women with cirrhosis (p = 0.028). Maternal therapy had no significant impact on the LBR (p = 0.24), termination rate (p = 0.72), miscarriage rate (p = 0.19) or gestational period (p = 0.8). Flares in AIH were more likely in patients who were not on therapy (p = 0.048) or who had a disease flare in the year prior to conception (p = 0.03). Patients who had a flare in association with pregnancy were more likely to decompensate from a liver standpoint (p = 0.01). CONCLUSIONS This study demonstrates that poor disease control in the year prior to pregnancy and the absence of drug therapy are associated with poor outcomes whist pregnant. These data should facilitate appropriate pre-conception counselling and appropriate pregnancy management in this cohort.
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Affiliation(s)
- Rachel H Westbrook
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom.
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Inflammatory bowel disease and pregnancy: evidence, uncertainty and patient decision-making. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:49-53. [PMID: 19172209 DOI: 10.1155/2009/531638] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Inflammatory bowel disease (IBD) often affects women during their child-bearing years. Management of a pregnant IBD patient, or a patient contemplating pregnancy, poses unique challenges and can be quite daunting. Knowledge of the basic interplay among disease, normal host physiology and pregnancy is vital to managing these patients. One of the most important advances in the management of IBD over the past decade has been the finding that normal pregnancy outcomes can be achieved when a woman enters the pregnancy in remission. New insights into the safety of a wider spectrum of drugs in these patients has allowed for increased success in IBD management. The evidence supporting medical interventions including biological therapy such as antibodies to tumour necrosis factor agents is reviewed. Once the treating physician understands this complex relationship, management of the pregnant IBD patient can often become a rewarding experience.
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Affiliation(s)
- Sharon E Maynard
- George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.
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Gazarian A, Abrahamyan DO, Petruzzo P, Kanitakis J, Guigal V, Garret J, Rizzo C, Durand PY, Fredenucci JF, Streichenberger T, Parmentier H, Galewicz T, Guillot M, Sirigu A, Burloux G, Morelon E, Braye F, Badet L, Martin X, Dubernard JM, Eljaafari A. Allogreffe de mains: expérience lyonnaise. ANN CHIR PLAST ESTH 2007; 52:424-35. [PMID: 17905506 DOI: 10.1016/j.anplas.2007.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 08/31/2007] [Indexed: 11/15/2022]
Abstract
Hand allograft is a method in the stage of clinical experimentation, which is reserved in France for the treatment of bilateral traumatic amputees. This study reports the Lyon team experience, which is pioneer in this domain. Four patients (3 males and 1 female) underwent seven (one unilateral and three bilateral) hand transplantations from September 1998 to February 2007. The level of amputation was at the wrist or at the mid-forearm. Delay since hand loss ranged from 2.5 to 9 years. The surgical protocol was elaborated and planned case by case. All recipients received the same immunosuppressive treatment. Episodes of acute rejection were observed in the first 3 months after transplantation, which were easily managed after a few days increasing oral prednisone doses and applying topical immunosuppressants. Currently the patients receive the doses of immunosuppressants comparable to those in kidney-grafted patients. We have not registered any severe complication of immunosuppressive treatment up till now (7 years follow-up for the earliest graft). We performed analytical and functional clinical, as well as questionnaire evaluation of patients. The first case (unilateral graft) resulted in graft failure at 2 years due to non-compliance of the patient. The three bilateral graftees demonstrate a favorable evolution despite some immunological (hyperglycemia, serum sickness) and surgical (thrombosis, osteomyelitis, skin loss) complications, which could be managed. The middle and long-term follow-up evaluation revealed good to excellent sensorimotor recovery of 4 hands in both male recipients (4 and 7 years) with satisfactory social adaptation, higher or equal to those expected after post-traumatic replantations at the equivalent level and higher to those obtained with currently available myoelectric prosthesis. The last patient, a young female who has been grafted in February 2007, receives ongoing reeducation course and shows normal progress of functional restoration of both hands. The encouraging results of this clinical experimentation make us currently consider hand allografting as reasonable and useful both for the patients and for evolution of research in composite tissues allotransplantation (CTA). Further long-term careful research and worldwide monitoring of all patients with hand allografts is required to, on the one part, state on the authorization of this surgery, and, on the other part, to better elucidate the mechanisms of successful CTA.
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Affiliation(s)
- A Gazarian
- Chirurgie de la main et du membre supérieur, clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France.
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Werner M, Björnsson E, Prytz H, Lindgren S, Almer S, Broomé U, Wallerstedt S, Sandberg-Gertzén H, Hultcrantz R, Sangfeldt P, Nilsson J, Danielsson A. Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding? Scand J Gastroenterol 2007; 42:986-91. [PMID: 17613929 DOI: 10.1080/00365520601155266] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In published studies there is a lack of data about the risks, management and how women with autoimmune hepatitis (AIH) decide on and are advised about pregnancy. The aim of this study was to investigate how women with AIH consider pregnancies, are advised and pharmacologically treated, as well as the outcome. MATERIAL AND METHODS A questionnaire was mailed to 128 women with AIH diagnosed during their fertile period and data from the Swedish National Birth Register was also used for matched controls. RESULTS There was an 83% response rate to the questionnaires. Sixty-three pregnancies were reported by 35 women. 48% did not consult their doctors before getting pregnant. More than half of the women reduced or stopped the immune suppression during pregnancy or breastfeeding. Some women were advised to abstain from pregnancy or even to have an abortion. Caesarean sections were performed more frequently in the AIH group (16% compared with 6.5% in the control group p<0.01). There were no significant differences in the number of stillborn infants or infants with malformations. However, 30% of the patients experienced flare-up after delivery. CONCLUSIONS In general, the outcome of pregnancy in women with AIH seems to be good. Current pharmacological treatment appears to be safe, including azathioprine during pregnancy and lactation. After delivery an active preparedness to increase pharmacotherapy should be considered.
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Affiliation(s)
- Mårten Werner
- Departments of Medicine, Sections for Hepatology and Gastroenterology, Umeå University Hospital, Umeå, Sweden.
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Schramm C, Herkel J, Beuers U, Kanzler S, Galle PR, Lohse AW. Pregnancy in autoimmune hepatitis: outcome and risk factors. Am J Gastroenterol 2006; 101:556-60. [PMID: 16464221 DOI: 10.1111/j.1572-0241.2006.00479.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Autoimmune hepatitis (AIH) may influence pregnancy outcome and pregnancy may affect AIH. We aimed at analyzing the disease course in pregnant AIH patients and at identifying disease-related risk factors for adverse pregnancy outcome. PATIENTS AND METHODS AIH patients with at least one pregnancy were identified at four liver units. The patients' records and the data obtained by detailed questionnaires were analyzed retrospectively. Forty-two pregnancies of 22 AIH patients were included. RESULTS The rate of adverse pregnancy outcome was 26%; a medical explanation could be elucidated in only 4 of 11 pregnancies with adverse outcome. Of note, the 7 unexplained adverse pregnancy outcomes were highly associated with the presence of antibodies to SLA/LP (odds ratio 51; p < 0.003) and Ro/SSA (odds ratio 27; p < 0.02). Of 35 live births, 30 children developed normally over a mean observation period of nearly 5 yr. Eleven of these had been exposed to azathioprine in utero. The rate of serious maternal complications was 9% and a high rate (52%) of postpartum flares was noted. CONCLUSIONS The presence of autoantibodies may be a risk factor for adverse pregnancy outcome in AIH patients. Close monitoring of both mother and fetus seems advisable due to a significant rate of maternal and fetal complications.
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Affiliation(s)
- Christoph Schramm
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Abstract
Myasthenia gravis (MG) is the best understood autoimmune disease, with well-characterized humoral and cellular effector mechanisms. It is not surprising, therefore, that immunotherapies play a key role in the management of MG. Significant progress has been made over the last few decades in the treatment of patients with MG, and the number of effective avenues of therapy continue to increase. In this review, we provide an update on management options in MG, highlighting recent literature on both traditional and more novel approaches.
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Affiliation(s)
- Gil I Wolfe
- From the *Department of Neurology, University of Texas Southwestern Medical Center Dallas, TX; daggerDepartment of Neurology, Western Galilee Hospital, Nahariya, Israel, and Bruce Rappaport School of Medicine, Israel Institude of Technology, Haifa, Israel
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Current awareness in prenatal diagnosis. Prenat Diagn 2004. [DOI: 10.1002/pd.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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