Advances in Transplant Medicine Make First Mothers Day a Reality For Parents of Twins

Los Angeles - May 3, 2007 – When five-month-old twins Isabella and Giovanni Velasco celebrate Mother's Day with their mom this year, they'll no doubt be unimpressed by the advances in medicine that made her pregnancy and their entire family's good health possible. But their parents and physicians know better.

For starters, both parents are kidney transplant recipients. Dad Johnny Velasco received a transplanted kidney as a teenager, and mom Norma Ponce became a kidney transplant recipient seven years ago. But that's only the beginning of the medical miracles responsible for the good fortune of this young Irvine, California family.

"Having a transplanted kidney and carrying twins already put Mrs. Ponce's pregnancy in a ‘high risk' category," said her obstetrician Calvin J. Hobel, MD, vice chair of the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center. "But adding the potential complications of lupus (an autoimmune disease which she developed in her teens) to the other issues put her in a ‘triple jeopardy' category. Her risk of having serious complications during her pregnancy was 75 to 80 percent."

"Usually, lupus remains stable in about one-third of pregnant women; in another third it will worsen, and some will have no problems with the disease during pregnancy. Thanks to a team of medical experts at Cedars-Sinai, Ponce was in the last category. Her only complication was anemia, which had two causes," Hobel explained. The kidney makes a very important hormone called erythropoietin that's responsible for producing red blood cells. Because she had a kidney harvested from a cadaver, it's likely that it wasn't producing enough erythropoietin to accommodate the 50 percent increase in blood volume that occurs with pregnancy. The second cause for the anemia was likely lupus. We initially gave her blood transfusions but later in the pregnancy we gave her a genetically engineered form of the missing hormone and she did very well and was able to carry the twins almost 37 weeks (38-40 weeks is considered a full-term pregnancy).

Lupus primarily affects women of childbearing age and can cause serious complications during pregnancy including anemia, hypertension, eclampsia, miscarriage and pre-term birth. While in the past women with lupus were discouraged from becoming pregnant, advances in managing the disease have significantly decreased the risks to both the baby and mother.

In addition to affecting the kidneys (it's likely that lupus nephritis caused Ponce's earlier renal failure), lupus also affects the skin, joints, heart, lungs, blood and brain and increases a person's susceptibility to infection. When Ponce had difficulty becoming pregnant after her marriage, doctors speculated that an infection that had developed in her Fallopian tubes before her kidney transplant may have caused her to become infertile. Five years after Norma married Johnny, she began fertility treatment at Cedars-Sinai and became pregnant with the twins.

The medical team that treated Ponce at Cedars-Sinai included Hobel and his staff and Stanley C. Jordan, MD, medical director of the Kidney Transplantation and Transplant Immunology, Kidney and Pancreas Transplant program.

"For me, the most dramatic aspect of Mrs. Ponce's pregnancy is the life-restoring capabilities of kidney transplantation," said Stanley C. Jordan, MD, a world-renowned research specialist and nephrologist at Cedars-Sinai who participated in the young mother's care both before and during her pregnancy. "From my standpoint, what's remarkable are the many advances in immunology that make it possible to safely carry a baby without worrying about anti-rejection medications harming the fetus. While she had to be followed closely throughout her pregnancy, both Mrs. Ponce and the babies have done very well."

Hobel, Jordan and their staffs were available to the couple throughout the pregnancy whenever they had a concern. Hobel gave the couple his pager number and frequently checked on them on weekends. "She had a good support system both from the medical professionals and her immediate and extended family," Hobel said.

Ponce isn't sure yet how she'll celebrate her first Mother's Day. When asked recently what a "normal" day was like for the mother of newborn twins, she laughed. "All day long I'm either carrying one or the other, feeding one or the other, changing one or the other, or putting one or the other to sleep … they usually don't sleep at the same time."

Like most moms, she'll likely be hoping for some extra rest on May 13.