Pregnancy following renal transplantation

Abstract

Pregnancy is not contraindicated in renal transplant recipients with stable renal function, and a successful and healthy obstetric outcome can be expected in 95% of such cases. The incidence of both maternal and fetal complications is related to the degree of graft dysfunction and/or hypertension prior to pregnancy. Poorer prognosis is associated with poorer renal function. If complications (usually hypertension, renal deterioration, and/or rejection) occur before 28 weeks, then successful obstetric outcome is reduced by 20%. More information is needed about the intrauterine effects and neonatal consequences of maternal immunosuppression, which appears harmless at maintenance levels. From the data available it seems that pregnancy does not compromise long-term transplant prognosis. In the absence of prospective controlled studies transplant pregnancy registries are the only viable means of providing clinicians with timely and relevant information on pregnancy outcomes on which to base management guidelines.

Pregnancy after Kidney Transplantation

“…Intrauterine devices are not optimal because they require an intact immune system for efficacy (31). Progestin-only oral contraceptives as well as estrogen/progestin are probably acceptable for use in this patient population as long as hypertension is well controlled (32)(33)(34). The best contraceptive agent to use after transplantation depends on considerations, made between the patient and her physician, of the desirability of pregnancy and considerations of the risks and benefits of each contraceptive method (30).…”

“…Historically, the recommendation was to wait 2 yr after successful transplantation (33). This recommendation has been replaced by the American Society of Transplantation Consensus Opinion that as long as graft function is optimal, defined as a serum creatinine Ͻ1.5 mg/dl, with Ͻ500 mg/24 h protein excretion, and no concurrent fetotoxic infections or use of teratogenic or fetotoxic medications, and immunosuppressive dosing is stable at maintenance levels, the patient can safely proceed with the pregnancy (30).…”

Pregnancy in chronic kidney disease and kidney transplantation

“…Also consistent were the preventative use of low dose aspirin to 345 reduce pre-eclampsia, and in severe hypertension. 52 Prior to conception, women should be 346 educated about the symptoms of pre-eclampsia. ACE inhibitors and angiotensin receptor 347 blockers should be stopped prior to pregnancy or as early as possible after discovering 348 pregnancy.…”

Medical Management of the Kidney Transplant Recipient

“…The overall post-transplant live birth rate was 73.5% compared to 66.7% for general US population; similarly, the overall post-transplant miscarriage rate of 14.0% was lower than 17.1%. Transplant recipients usually deliver late preterm (34-36 weeks), roughly 30-50% pregnancies experience intra-uterine growth restriction to some degree and on average give birth to low birth weight babies (~2.5 grams) (70)(71)(72). Pregnancy doesn't increase the risk of rejection (71).…”