Neonatal Outcomes After Uterine Transplant Reflect Gestational Age

(Reuters Health) – Infants delivered via cesarean section after uterus transplantation appear to have outcomes similar to what’s expected for newborns of the same gestational age, a small study suggests.

Researchers examined data on 12 infants born to 11 women who underwent embryo transfer between 105 and 218 days after uterine transplant and had singleton pregnancies; one woman in the study had two pregnancies. Overall, the infants’ mean gestational age was 36 weeks and 6 days (range: 30 weeks and 6 days to 38 weeks), and median birth weight was 2,920 grams (range: 1,770–3,470 g).

All the infants developed normally during pregnancy and had neonatal outcomes over the first two months of life that were in line with typical outcomes for infants of a similar gestational age born to mothers who didn’t undergo uterus transplants, researchers report in the American Journal of Perinatology.

“The infants born after uterus transplantation in this study developed normally during pregnancy. This outcome differs from the outcome of infants born to mothers after other organ transplants, where an association with preterm delivery and small-for-gestational-age infants has been seen,” said senior study author Dr. Liza Johannesson, medical director of uterus transplant at Baylor University Medical Center in Dallas, Texas

“It is important to remember that the women undergoing uterus transplantation are healthy and it may be the underlying disease in other organ transplanted mothers that is the cause to the different outcomes seen,” Dr. Johannesson said by email.

One-minute Apgar scores ranged from 4 to 9, while five-minute Apgar scores ranged from 8 to 9.

Birth weights for all the infants ranged from the 18th to the 88th percentile. In addition, frontooccipital circumference ranged from 28 to 36.5 centimeters and body length ranged from 43 to 50.5 centimeters.

Bandemia presented in two infants but both cases resulted in negative blood cultures.

There was no increased risk of congenital birth defects.

Day of life at discharge ranged from 3 to 38 days and postconceptual age at discharge ranged from 36 weeks and 1 day to 38 weeks and 3 days. One baby was discharged with a nasal canula.

The small size and brief follow-up period are limitations of the study, however, the report is the largest to date from a single center, the authors note.

“I think the results from this center can be extrapolated to other experienced uterus transplant centers,” said Dr. Kathleen O’Neill, an assistant professor of obstetrics and gynecology at the University of Pennsylvania in Philadelphia and a principal investigator for Penn’s uterus transplant clinical trial. More research is needed, however, to determine to the effects on the development of the immune system in children born to women following uterus transplant, Dr. O’Neill added.

“Children born to women following uterus transplant develop appropriately and do not demonstrate increased risks of congenital anomalies or other complications, which suggests uterus transplant is a safe and effective way in which women with absolute uterine factor infertility can achieve parenthood,” Dr. O’Neill, who wasn’t involved in the current study, said by email.

SOURCE: American Journal of Perinatology, online April 20, 2021.

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