Children of renal transplant recipient mothers

Abstract

Despite a high incidence of preterm delivery, low birth weight, intrauterine growth retardation and urinary tract abnormalities, the overall outcome for children of renal transplant recipient mothers is good.

Bioethical considerations

“…However, in places where it is influential, the movement for "natural" childbirth is a potent merger of scientific, moral, and political discourses; finding oneself outside such a framework can not only create stress but also inhibit a discussion of negative aspects of pregnancy where transplanted recipients silently cope with their own mortality and attempt to conform to a perfect pregnancy [19]. Anxiety about their "unnatural" pregnancy may subsequently contribute to maternal discontinuation of immunosuppressant drug regimens f [6,8]. Transplant mothers persuaded by the natural childbirth literature must weigh the presumed harm to the unborn child against harm to the graft and hence their own ability to sustain the pregnancy or survive to parent the child; such a calculus is not in the scope of the natural childbirth movement.…”

“…It is increasingly recognized that the complications of immunosuppression are cumulative. While very little research has been conducted on the issues of parenting as a transplant recipient, existing qualitative research indicates that the precariousness of recipient lives adds to the stresses of parenting and generates profound worries about how their illness impacts their children [6,24]. For all transplant recipients e even those who have alternative therapies such as dialysis or those who are able to be retransplanted e there exists a real possibility that one will be parenting under the duress of organ failure and chronic illness, including dealing with medication side effects as well as integrating medical appointments into an already busy schedule.…”

“…These positive insights, however, compete with the angst produced by an uncertain future and its potential effect on loved ones [6,34]. For example, transplanted mothers cope with guilt over the lack of energy to fulfill household responsibilities, conflict over changing roles and routines, and the potential depletion of financial resources [35e37].…”

“…The expectation that transplantation can, or perhaps ought to, generate reproductive opportunities is inherent in the pursuit of uterine transplants. Yet the very idea that pregnancy could be considered an "expected" benefit of transplant is itself novel and a reversal of the earlier perspective that posttransplant pregnancies posed too many threats to the health of the mother, the child, and the graft organ [5,6].…”

Pre-pregnancy care and counselling in chronic renal patients

“…Thus, evaluation of the immune system and paediatric follow-up are needed. To date, information about general progress in early childhood has been good [45].…”