Level of Knowledge of Post-Transplant Women About Breastfeeding During Immunosuppression.

BACKGROUND: The number of women treated with immunosuppressants is increasing. Often, these women are of childbearing age. Consequently, they must face the decision of whether to breastfeed when they do have a child. Although available studies recommend breastfeeding during immunosuppression, patients appear to need more knowledge to enable the decision-making process. This study aimed to investigate the knowledge of women after transplantation about breastfeeding during immunosuppression and their source of information. MATERIAL AND METHODS: We performed a cross-sectional study from February 1 through August 31, 2022, with 45 female graft recipients (28 post-kidney and 17 post-liver transplantation) of childbearing age (15-49 years). The women were polled during their routine outpatient appointments and then divided into 2 groups: parous women (group 1, n = 26) and nulliparous women (group 2, n = 19). RESULTS: Most of the patients (84%) were administered tacrolimus-based regimens. Thirty-seven women voiced concerns about the possible harm to their babies through immunosuppressants in their breast milk (82%). The average score for knowledge of the benefits of breastfeeding was 51%; 58% in group 1, and 41% in group 2. Among parous women, 5 breastfed on immunosuppression, 15 did not, and the remainder did not take immunosuppression during breastfeeding. The decision regarding breastfeeding was influenced mainly by counseling from gynecologists (75%) and transplantologists (56%). CONCLUSION: Women's knowledge about the benefits of breastfeeding and the possibility of it during immunosuppression is not satisfactory.

Does Intrauterine Exposure of the Foetus to Immunosuppressive Drugs Used by the Mother-The Organ Recipient-Affect the Development of Post-Vaccination Immunity against Selected Viral Diseases in Children of These Mothers in Postnatal Life?

BACKGROUND: Pregnancy in women who are organ recipients has long been a controversial issue due to the lack of data on the safety of immunosuppressive drugs for the developing foetus. Scientific data show that the effect of immunosuppressants on the foetus causes an impairment of T and B lymphocyte function and a reduction in their total number. For this reason, some authors recommend delaying the obligatory immunization of infants. The aim of the study is to analyse the impact of chronic immunosuppressive therapy used during pregnancy by women after organ transplantation on the effectiveness of anti-viral vaccinations in the children of these women. METHODS: Concentrations of post-vaccination IgG antibodies (measles, HBV, polio) in 18 children of post-transplant mothers (9KTRs; 9LTRs) were determined using the ELISA method. The results were compared with the control group (n = 21). The incidence of vaccination AEs was also analysed. RESULTS: There were no significant differences between the analysed groups in the concentrations of antibodies against HBV, measles and polio (p > 0.05). CONCLUSIONS: No difference was observed in the immunogenicity of HBV, polio and measles vaccinations between children of post-transplant mothers and the general population. The immunization of children of post-transplant mothers is safe, and the percentage of adverse post-vaccination events does not differ from the general population. The obtained study results do not indicate the necessity for modifying the vaccination program for HBV, measles, and polio in this group of patients.

A case of necrotizing enterocolitis in full-term infant on his first day of life-Early presentation with multifactorial etiology.

We aimed to show the complexity of NEC in the full-term newborns. Additionally, we wanted to underline the importance of breastfeeding from the first day of life and show how deteriorating effect the antibiotics can have on gastrointestinal tract.

Assessment of Anti m-RNA SARS-CoV-2 (BNT162b2) Antibody Titres in Mother and Child Pairs of Breastfeeding Women Vaccinated Post-Delivery.

The global response to the COVID-19 pandemic has been successfully driven by efforts to ramp up access to vaccines. Pregnant or breastfeeding women and their children have not benefited from the vaccines despite their susceptibility to the virus. We investigated whether women who were offered vaccination after delivery passively transferred protective antibodies to their infants via breast milk. Serum was collected from breast feeding mother-infant pairs and analysed for levels of antibodies to the SARS-CoV-2 spike protein using the CLIA chemiluminescence technique. Data were analysed for the significance of the differences using the Mann-Whitney U test and the Spearman's rank correlation coefficient to determine the strength of the correlation. A total of 13 mothers, mean age 34.86 (95%CI = 33.21-36.48) years and their infants, mean age 15.77 (95%CI = 11.24-20.29) months were enrolled. The mothers had completed their courses of the mRNA BNT162b2 SARS-CoV-2 vaccine during breastfeeding, 8.3 (95%CI = 7.24-9.36) months before the study. All 13 mothers had detectable antibodies to the SARS-CoV-2 spike protein, mean 1252, (95%CI = 736-1769) BAU/mL. Antibodies were detected in 3/13 (23%) breast-fed infants mean 322, (95%CI = 252-897) BAU/mL. There was no correlation between the maternal and infant IgG antibody titres. The time-lag since full vaccination did not correlate to the presence of antibodies in infant sera. Maternal or infant ages did not correlate to the presence of antibodies. Although some children (23%) had anti-SARS-CoV-2 antibodies, there was no association between vaccine-induced COVID-19 spike protein specific maternal IgG antibody titres and the presence of antibodies in the breastfed infants. The data show that the transfer of passive immunity to infants following post-partum vaccination with the mRNA BNT162b2 SARS-CoV-2 vaccine may be infrequent in this population.

Influence of prenatal steroid therapy on the incidence of respiratory disorders in late premature infants.

OBJECTIVES: This study was conducted because of conflicting data on the role of corticosteroids administered before delivery in the late premature period. The aim of the study was to assess the frequency of respiratory disorders in 'late premature infants' and the impact of using prenatal steroid therapy. MATERIAL AND METHODS: The study included 513 newborns born between the 34-36 week of pregnancy. They were divided into two groups. In the first group, there were 439 newborns (85.58%) who did not receive prenatal steroid therapy, and in the second group, there were 74 newborns (14.42%) born after the prenatal steroid course. The frequency of occurrence of respiratory disorders requiring the use of non-invasive respiratory support methods as well as intubation and mechanical ventilation was compared in both groups. RESULTS: In the group of premature infants after steroid therapy 43/74 (58.12%) did not require respiratory support compared to the group of infants without prenatal steroid therapy where in 368/439 (83.8%) cases no respiratory disorders were found. CONCLUSIONS: If there is a risk of preterm labor in the 34-36 week of pregnancy, the use of steroid therapy should be considered. Steroidotherapy at this moment of gestation may not be such beneficial, like in the more premature delivery, before 34 weeks of pregnancy.

The influence of selected factors on the immunogenicity of preventive vaccinations against hepatitis A, B and influenza in solid organ transplant recipients undergoing immunosuppressive therapy - a review.

INTRODUCTION: Immunization is the most effective form of the primary prevention of infectious diseases. Knowledge on the efficacy and immunogenicity of vaccinations in the group of organ transplant patients taking chronic immunosuppressive treatment remains incomplete. AREAS COVERED: The aim of this paper was to analyze factors influencing the post-vaccination response in patients undergoing chronic immunosuppressive therapy based on a literature review. Only publications that evaluated the immunogenicity of influenza, HAV and HBV vaccinations in patients on immunosuppressive therapy were reviewed. EXPERT OPINION: The following methods are used to potentially increase the immunogenicity of vaccinations against HAV and HBV amongst post-transplantation patients: increasing the number of doses, increasing dose volumes, the method of administering as well as the addition of adjuvant. Immunogenicity is also impacted by the immunosuppression mechanism. Overall, vaccination has been concluded to be safe for post-transplantation patients and adverse events following immunization (AEFI) have typically been rated as mild or moderate. The instances of transplant rejections as observable in the long term have not been related to administered vaccinations. The data shows certain correlations of some factors with increased immunogenicity, however it is necessary to repeat the studies on a more representative group of patients.

Evaluation of selected parameters of immune response to rubella virus, hepatitis B virus and varicella-zoster virus infections in children born to mothers after kidney or liver transplantation.

BACKGROUND: The immune status of children exposed prenatally to immunosuppressants is not fully understood. MATERIAL AND METHODS: A single-center study evaluated possible differences in antibody levels between children prenatally exposed to immunosuppressants born to mothers after hepatic or kidney transplantation (study group) compared to children without prenatal exposure to immunosuppressants (control group). Children from the study and control group were age-matched at the time of the examination and gestational age-matched, so as to obtain similar stages of the vaccination schedule and to enable reliable comparison of the results. The selection of children was made in a 1:1 ratio. The study population, a total of 138 children, was divided according to the age of the children at the time of the study into three age groups: newborns, infants (from 29 days to 1 year) and children aged >1 year. Immunoenzymatic tests were used to analyze the titers of the chickenpox virus (VZV-IgG), rubella (RuV-IgG) and hepatitis B virus (HBV, HBsAb). The studied differences were compared depending on the age group and the immunosuppressive regimen used by the pregnant mother. RESULTS: In neonates born to mothers after liver transplantation, significant differences were found in HBsAb levels (>250 mIU/ml) compared to newborns without prenatal exposure to immunosuppressants taken by pregnant mothers (11/16, 69% vs. 4/14, 29%, respectively; p = .028). A similar difference in the level of HbsAb was no longer noted at later stages of children's lives. In infants, these values were 80% (4/5) vs. 33% (2/6), and in children over 1 year of age 15% (7/48) vs. 12% (6/49), respectively. No other significant differences were noted when compared the distribution of measured parameters of VZV and RuV in both analyzed groups (children of mothers after kidney or liver transplantation chronically treated with immunosuppression and children without prenatal exposure to immunosuppression). CONCLUSIONS: Prenatal exposure to immunosuppressive therapy does not appear to affect VZV, RuV and HBV antibody levels in children of mothers who have had a kidney or liver transplant. Initially elevated HBSAb levels in newborns of mothers after liver transplantation are not observed in later stages of life.

Catheter-Guided Dissolution of a Giant Thrombus in the Left Ventricle in a Newborn.

A newborn with pulmonary hypertension due to the premature fetal arterial duct occlusion was diagnosed with a giant left ventricle thrombus. Cardiopulmonary compromise required multidrug therapy with vasopressors infusions, high-frequency oscillation, and nitric oxide. Alteplase infusion through a guiding catheter into the left atrium dissoluted the clot without sequelae. (Level of Difficulty: Advanced.).

Serum S100B Protein Concentrations in SGA/FGR newborns.

OBJECTIVES: Fetal growth restriction is associated with chronic fetal hypoxia, poor perinatal outcome and increased perinatal mortality. There are no reliable methods to detect cell damage in the central nervous system (CNS) in these patients. The findings of increased an acidic calcium-binding protein (S100B) concentration in biological fluids of infants after brain injury have supported the use of S100B as a biochemical marker of CNS damage. The purpose of the study was to assess blood S100B concentrations in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns and to evaluate the usefulness of S100B for early detection of hypoxia. MATERIAL AND METHODS: The investigation was carried out between November 2011 and April 2014. Serum S100B protein level was assessed in cord blood collected from newborns after birth. Medical records of mothers of neonates studied were reviewed for pregnancy induced hypertension (PIH), preeclampsia, maternal smoking during pregnancy and abnormalities in umbilical artery (UA) Doppler ultrasound examination. RESULTS: The study was carried out in 88 SGA neonates and 80 AGA neonates. The median value of S100B protein concentration in the SGA study group was significantly higher than in AGA controls (p < 0.001). Cord blood serum S100B concentration in SGA neonates with prenatal normal UA Doppler ultrasound findings (n = 32) did not differ from that SGA neonates with abnormal prenatal UA Doppler findings (n = 25) (p = 0.74), but was significantly higher than in AGA newborns (p < 0.001). CONCLUSIONS: Elevated S100B protein levels in cord blood collected from SGA newborns may be helpful in detecting infants at higher risk of postnatal neurologic disturbances at an early stage.

Barley malt-based composition as a galactagogue - a randomized, controlled trial in preterm mothers.

OBJECTIVES: Delayed or insufficient breast milk production, as well as low milk supply, is still a challenging problem to overcome, particularly in the case of preterm delivery. Herbal galactagogues might be a good way to increase milk supply, however, there is a lack of clinical studies confirming their efficacy and safety. The aim of this study was to verify the safety and effectiveness as a galactagogue of the unique galactagogue composition based on barley malt with ß -glucan and lemon balm. MATERIAL AND METHODS: The study included 117 mothers of preterm infants randomly divided into the Galactagogue Group given galactagogue and the Placebo Group. A complete data set was obtained for 80 participants, divided equally between two groups. Volume of milk expressed by mothers during the first two weeks after delivery was the primary outcome and safety of the product was the secondary outcome. RESULTS: Volume of milk recorded on participants' last visit in the Galactagogue Group was significantly higher than in the Placebo Group (95 mL vs 62.5 mL, p = 0.049). The total expressed milk volume during the study was 4209 ± 335 mL in the Placebo Group vs 6036 ± 498 mL (p = 0.003) in the Galactagogue Group. CONCLUSIONS: Supplementation with unique Galactagogue composition was safe and increased milk output which allowed achieving target minimal volume of 500 mL per day in first week of lactation in preterm mothers.

Does pregnancy influence eye parameters? Assessment of choroidal thickness using EDI-OCT before and after labour depending on the way of delivery method.

OBJECTIVES: The aim of this study is to assess the choroidal thickness (CT) with use of EDI-OCT in patients before and after delivery depending on the mode of delivery. MATERIAL AND METHODS: The study involved 146 eyes of 73 patients aged 20-34 years, after natural labour (66 eyes) and C-section (80 eyes). Main inclusion criteria: Informed consent to participate in the study, age 18-35 years, single pregnancy, spherical refraction error -4.00 to +4.00 D, no eye pathologies, no surgery and ophthalmic procedures-including refractive surgery, childbirth after 36 weeks of pregnancy, BCVA = 1.0. Patients were examined twice: in 36 WG and on 6th week after the birth. All examinations were carried out between 8:00 am and 10:00 am in order to avoid daily cycle fluctuations. CT measurements were made manually by two independent researchers at: subfoveal and 500 µm, 1000 µm, 1500 µm, 3000 µm temporally and nasally. The student's t-test was made. RESULTS: In C-section group CT differences before and after delivery were statistically significant in 7/9 of the analysed areas. Mean subfoveal choroidal thickness was 370.86 µm vs 388.71 µm in 36 WG and in 6th week postpartum respectively (p = 0.0003). In women after natural labour, differences were statistically significant in 3/9 of the analysed areas. Mean subfoveal choroidal thickness was 303.27 µm vs 308,34 µm in 36 WG and in 6th week postpartum respectively (p = 0.4800). CONCLUSIONS: The thickness of the choroid was lower in women in 36 WG in comparison to 6th week after birth. Changes in the thickness of the choroid are particularly noticeable in women after caesarean section.

Low Content of Cyclosporine A and Its Metabolites in the Colostrum of Post-Transplant Mothers.

The rate of post-transplant mothers who breastfeed while on immunosuppression is progressively increasing. Data on breastfeeding while on cyclosporine-based regimens are limited. Therefore, we assessed the amount of cyclosporine and its metabolites that might be ingested by a breastfed infant by measuring the concentration of cyclosporine and its metabolites in the colostrum of seven post-transplant mothers. The mean concentration of cyclosporine in the colostrum was 22.40 ± 9.43 mcg/L, and the estimated mean daily dose of the drug was 1049.22 ± 397.41 ng/kg/24 h. Only three metabolites (AM1, DHCsA, and THCsA) had mean colostrum amounts comparable to or higher than cyclosporine itself, with the daily doses being 468.51 ± 80.37, 2757.79 ± 1926.11, and 1044.76 ± 948.56 ng/kg/24 h, respectively. Our results indicate a low transfer of cyclosporine and its metabolites into the colostrum in the first two days postpartum and confirm the emerging change to the policy on breastfeeding among post-transplant mothers. A full assessment of the safety of immunosuppressant exposure via breastmilk will require further studies with long-term follow-ups of breastfed children.

Evaluation of Lipid Profile in Children Born to Female Transplant Recipients.

INTRODUCTION: Being aware of the nephro- and hepatotoxic effects of most immunosuppressants, assessing their potential effects on the health of the offspring is an important aspect of deliberate family planning after organ transplantation. AIM: The aim of the study was to evaluate the influence of immunosuppressive drugs used by pregnant women after kidney or liver transplantation on the lipid profile of their children. MATERIALS AND METHODS: Ninety-one children born to mothers after kidney or liver transplantation (study group) and 91 children of healthy mothers from the control group (control group) were included in the study. Transplant donors received immunosuppressive treatment in monotherapy or combination regimens during pregnancy. The study compared lipidogram values including total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. The lipidogram was analyzed depending on the following 3 most commonly used immunosuppressive regimens: study group 1: CI (calcineurin inhibitors); study group 2: CI + GCs (glucocorticosteroids); and study group 3: CI + GCs + AZA (azathioprine). RESULTS: There were no significant differences between study group and control group in mean total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglyceride levels (P > .05). In each of the studied subgroups, at least 1 abnormal lipidogram fraction was noted. Frequency of these deviations in study group 1, study group 2, and study group 3 were 31%, 57%, and 26%, respectively. However, no statistically significant differences were found between these obtained results (P > .05). CONCLUSIONS: Prenatal exposure to immunosuppressants taken by the mother after liver or kidney transplantation does not appear to significantly affect the occurrence of lipid disorders in these children.

Selected Biochemical Parameters in Children of Mothers After Kidney Transplantation.

INTRODUCTION: The number of pregnant kidney graft recipients receiving immunosuppressive drugs is increasing yearly. All potentially nephrotoxic and hepatotoxic immunosuppressive drugs penetrate through the placenta, which raises questions about their long-term effects on offspring. OBJECTIVES: The study aimed to evaluate the influence of immunosuppressive drugs used by pregnant women after kidney transplantation on the biochemical parameters of their children. MATERIALS AND METHODS: Forty children born to mothers after kidney transplantation (KTx) and 40 children of healthy mothers from the control group were included in the study. All graft-recipient mothers received immunosuppressive treatment during pregnancy. The study compared biochemical parameters, including urea, creatinine, potassium, and sodium, in both groups. RESULTS: Elevated creatinine level was observed in 1 newborn in the KTx group and none of the children from the control group (P = .500). All KTx children had normal urea levels, while in the control group, 2 newborns had an increased level of urea (P = .247). Elevated potassium levels were observed in 10% of children in the KTx group and 20% of children in the control group (χ2 = 0.881; P = .348). Elevated sodium levels were observed in 22.5% of children in the KTx group and 32.5% of children in the control group (χ2 = 1.001; P =.317). No child in the KTx group had hyponatremia; mild hyponatremia was observed in 5% of children in the control group (P = .247). CONCLUSION: There was no increased risk of an abnormal concentration of urea, creatinine, sodium, and potassium in the offspring of mothers after kidney transplantation using immunosuppressive drugs during pregnancy.

Does Caesarean Section or Preterm Delivery Influence TGF-ß2 Concentrations in Human Colostrum?

Human colostrum (HC) is a rich source of immune mediators that play a role in immune defences of a newly born infant. The mediators include transforming growth factor ß (TGF-ß) which exists in three isoforms that regulate cellular homeostasis and inflammation, can induce or suppress immune responses, limit T helper 1 cells (Th1) reactions and stimulate secretory immunoglobulin A (IgA) production. Human milk TGF-ß also decreases apoptosis of intestinal cells and suppresses macrophage cytokine expression. The aim of the study was to determine the concentration of TGF-ß2 in HC obtained from the mothers who delivered vaginally (VD) or by caesarean section (CS), and to compare the concentrations in HC from mothers who delivered at term (TB) or preterm (PB). In this study, 56% of preterm pregnancies were delivered via CS. The concentrations of TGF-ß2 were measured in HC from 299 women who delivered in the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw: 192 (VD), 107 (CS), 251 (TB), and 48 (PB). The colostrum samples were collected within 5 days post-partum. TGF-ß2 levels in HC were measured by the enzyme-linked immunosorbent assay (ELISA) test with the Quantikine ELISA Kit-Human TGF-ß2 (cat.no. SB250). Statistical significance between groups was calculated by the Student t-test using StatSoft Statistica 13 software. The mean TGF-ß2 concentration in patients who delivered at term or preterm were comparable. The levels of TGF-ß2 in HC were higher after preterm than term being 4648 vs. 3899 ng/mL (p = 0.1244). The delivery via CS was associated with higher HC concentrations of TGF-ß2. The levels of TGF-ß2 were significantly higher in HC after CS than VD (7429 vs. 5240 ng/mL; p = 0.0017). The data from this study suggest: caesarean section was associated with increased levels of TGF-ß2 in HC. The increased levels of TGF-ß2 in HC of women who delivered prematurely require further research. Early and exclusive breast-feeding by mothers after caesarean section and premature births with colostrum containing high TGF-ß2 levels may prevent the negative impact of pathogens which often colonize the gastrointestinal tract and may reduce the risk of chronic diseases in this group of patients.

Unintended pregnancies and family planning among women after kidney or liver transplantation.

Background: To evaluate the incidence of unplanned pregnancies in female organ transplant recipients.Methods: In a single-center cross-sectional study 252 women aged 18-45 years who underwent kidney or liver transplantation were asked to fill in a survey form.Results: 217 (86%) women were enrolled in the study. Fifty-three percent of women declared 181 pregnancies, of which 30% (54/181) were unplanned. Women more frequently consulted their conception with a doctor post-transplantation (74 versus 88%, p = .064). The number of unplanned pregnancies decreased post-transplantation (34 versus 20%, p = .051). The mean time elapsed from an organ transplant to unintended conception was 27.0 ± 12.5 (3.0-63.0) months. Women with longer (>24 months) rather than shorter (≤24 months) time elapsed from the transplant became pregnant less frequently (38 versus 15%, p = .060). In 70% (38/54) of unplanned pregnancies women did not use any birth control. All cases of conceptions within the post-transplant year were unintentional. Every third woman, who underwent the transplantation up to 1 year before the study enrolment, was unaware of the necessity to prevent the pregnancy.Conclusions: Although unwanted pregnancies occur more frequently in the early post-transplant period, it seems that women after kidney or liver transplantation seem to plan their pregnancies more carefully.

Evaluation of the body mass index (BMI) in children born to organ transplant recipients.

BACKGROUND: Overweight and obesity are one of the most serious clinical health problems. Until now, the long-term development of children born to mothers after transplantation is unknown. In this study, we attempted to present the analysis of the prevalence of overweight in the population of mothers after kidney or liver transplants. METHODS: A comparison of body mass index (BMI) measurements performed in 61 children of kidney transplant women (study group) and 64 children born to healthy mothers (control group). The children from both groups were born at a similar gestational age and in the similar time period from 12/1996 to 11/2010. BMI was measured once on one of the follow-up visits in the time period from 07/2010 to 11/2013. BMI was assessed in infants older than one month as well as in toddlers or children in the preschool or school age. The results obtained in the study group of children born to transplanted mothers were compared with control group results and with the theoretical population data. RESULTS: There were no differences in the incidence of underweight and overweight, when BMI values of children born to transplanted mothers were compared to those of children of healthy mothers. There was a trend towards a greater incidence of obesity in children of studied group compared to controls (16 versus 6%, p = .072). Among analysed factors, it was noted that prenatal exposure to tacrolimus was associated with a 2.8-fold increased risk of developing a higher BMI in later follow-up. CONCLUSIONS: Obesity among children of mothers after kidney or liver transplants seems to be more frequently observed. This observation may be an important factor in the further paediatric care, especially in children born to transplanted mothers treated chronically with tacrolimus.

Neurological development of children born to mothers after kidney transplantation.

BACKGROUND: Pregnancies after kidney transplantation are at high risk of complications such as preterm birth and foetal growth restriction. Until now, the impact of these factors on neurological development of children born to transplant mothers has not been established. AIMS: A comparison of neurological examinations performed in 36 children of kidney transplant women (study group) and 36 children born to healthy mothers (control group). The children from both groups were born at a similar gestational age and in the similar time period from 12/1996 to 09/2012. Neurological examinations were performed from 07/2010 to 11/2013. Each examination was adjusted to the patient's age and performed after the neonatal period. Three years later children were re-consulted, if they presented neurological deviations or were less than 12 months old at the time of the first examination. RESULTS: Normal neurological development was found in 86% of children in both groups (p = .999). Mild neurological deviations were observed in four (11%) children born to kidney transplant mothers and in five (14%) children born to healthy mothers (p = .999). Moderate deviations were diagnosed in one premature child born to transplant mother, whose pregnancy was complicated with a severe preeclampsia and foetal growth restriction. In the study population, no severe neurological disorders were found. Almost all (8/10) children with neurological deviations were born prematurely in good general conditions. The neurological deviations observed in the first year of life were mild and transient. In children over 1 year of age, deviations were more pronounced and continued to maintain. CONCLUSIONS: The neurological development of children of kidney transplant women is similar to that of the general population and possible deviations seem to be the result of intrauterine hypotrophy and prematurity. Therefore, in clinical practice, it is necessary to plan post-transplant pregnancies especially in women at high risk of these complications.

Skin changes during pregnancy. Is that an important issue for pregnant women?

OBJECTIVES: The aim of the study was to investigate the prevalence of self-reported skin complaints during pregnancy, applied treatment and the impact on well-being of pregnant women. MATERIAL AND METHODS: We asked 1935 women that were maximum 4 years after labor to fill in our questionnaire. The questionnaire included questions concerning the course of pregnancy, observed skin lesions, applied treatment and influence on the quality of life. RESULTS: Skin changes during pregnancy were reported by 1447 patients (74.78%). The prevalence of self-reported skin complaints were as follows: stretch marks (77.4%), acne (21.6%) and recurrent herpes labialis (11.6%). In 43.67% (n = 632) of women who reported dermatological problems during pregnancy the disease caused significant deterioration in their well-being. Only 168 patients (11.61%) received dermatological treatment from their obstetricians. Dermatological con-sultation required 217 patients (14.99%). For 133 of treated women (25.68%) the recommended treatment was expensive. However, in the majority of patients (379; 73.15%) who received treatment the skin changes resolved after therapy. Skin symptoms resolved significantly faster in the treated group (3.5 ± 4.3 week vs 5.8 ± 6.2 week; p < 0.001). CONCLUSIONS: Self-reported skin complaints seem to be a relevant problem during pregnancy. Proper skin care as well as appropriate treatment applied by obstetricians and/or dermatologists may help women to recover.