Woman with Transplanted Small Bowel Gives Birth: A First for Georgetown and Thought to be Just the Second in the US

For the first time at Georgetown University Hospital and just the second time in the United States, a mother with a previous small bowel transplant had an uncomplicated pregnancy and full-term delivery. Tashia Alston, 26, of Fort Washington, Maryland gave birth to a healthy baby girl on October 24, 2011.

October 28, 2011

Maryland Woman “Excited” Over Successful Birth of Daughter

(Washington, D.C.) – For the first time at Georgetown University Hospital and just the second time in the United States, a mother with a previous small bowel transplant had an uncomplicated pregnancy and full-term delivery. Tashia Alston, 26, of Fort Washington, Maryland gave birth to a healthy baby girl on October 24, 2011.

“Though we have cared for a number of pregnant women with other types of organ transplants, this was the first time for a pregnancy after an intestinal transplantation. As with so many high risk patients, there was not a lot of information in the medical literature for guidance.” said Helain J. Landy, MD, a specialist in Maternal-Fetal Medicine and Chair of the Department of Obstetrics and Gynecology at Georgetown.“The team of specialists including the transplant team, kidney specialists, and the high-risk obstetricians at GUH, monitored her progress very closely. Her delivery was smooth and uneventful.”

Ms. Alston received a small bowel transplant three years ago after a failed gastric bypass. She already has an older daughter who was delivered prior to her transplant surgery, so having a pregnancy after a transplanted small bowel was a new phenomenon for her—taking many different medicines and involving many more office visits, sonograms, and blood tests—as well as for her medical team.

“I knew I was an unusual case, but I was never nervous,” said Ms. Alston the day following her daughter’s birth. “I didn’t really worry; I was just happy to be pregnant. I had to be sure to take my medications and do everything I was supposed to do so that we’d both be healthy. Other than that it didn’t feel any different from my previous pregnancy.”

At about 20 weeks, a potential problem arose when her kidney function began to decline under the combination of anti-rejection drugs for her transplanted small intestine and her pregnancy.

“We watched the renal lab tests very carefully, especially since underlying kidney problems can pose significant problems to a developing baby” said Dr. Landy. “Fortunately, the baby continued to thrive, and Ms. Alston did not show any signs of high blood pressure."

Cal Matsumoto, MD, director of small bowel transplantation at Georgetown University Hospital was Ms. Alston’s transplant surgeon. “Our initial worry was how to provide adequate immunosuppression to the transplanted small intestine,” said Dr. Matsumoto. “We didn’t know how the medications would affect the baby. Our transplant team watched her closely and coordinated with Dr. Landy’s team and we couldn’t be more pleased about this successful outcome. “

Why is giving birth such an unusual occurrence in someone who has had a small bowel transplant? “Right now in the United States there are so few small bowel transplants performed—only about 130–150 a year,” said Dr. Matsumoto. “And half of those are men, and many of them are small children or infants. This was a unique experience for us to handle. If we ever have another case like Ms. Alston’s we’ll have some experience under our belts. As more and more people are receiving and surviving small bowel transplants, I would expect that we will see more cases like hers.”

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