Neonatal and long-term outcomes in infants born to mothers after solid organ transplantation: a narrative review with Polish cohort data.

INTRODUCTION: To review current evidence on pregnancy, neonatal, and long-term outcomes in infants born to transplant recipients, with particular emphasis on the effects of maternal immunosuppressive therapy, and to present data from a Polish cohort, including breastfeeding exposure. A narrative review of the literature was conducted, focusing on maternal, neonatal, and long-term outcomes after solid organ transplantation. Registry data, cohort studies, and pharmacokinetic analyses of immunosuppressive drug transfer into breast milk were included. Findings from a Polish cohort of transplant recipients and their offspring were analyzed to complement available evidence. CONTENT: Pregnancy in transplant recipients is feasible but remains high risk, with increased rates of preterm birth and intrauterine growth restriction. Neonatal outcomes are largely determined by prematurity, while the incidence of major congenital malformations is comparable to the general population when recommended immunosuppressive regimens are used. Temporary alterations in neonatal immune parameters and mild neurological impairment may occur but are not associated with significant long-term sequelae. Available data indicate generally normal growth, neurodevelopment, and immune function. Breastfeeding exposure to corticosteroids, azathioprine, and calcineurin inhibitors is minimal. Data from the Polish cohort confirm low transfer of tacrolimus and cyclosporine into breast milk and favorable infant outcomes. SUMMARY AND OUTLOOK: With appropriate multidisciplinary care, pregnancy and breastfeeding in transplant recipients can be managed safely. Neonatal risk is primarily related to prematurity, while long-term outcomes appear reassuring. Breastfeeding may be supported in selected patients receiving compatible immunosuppressive therapy. Continued long-term follow-up and prospective studies are needed.