1. Post-kidney transplant pregnancies are mostly successful and outcomes are improving.
2. Babies of kidney transplant recipients are more likely than the general population to be premature and have higher perinatal mortality.
Evidence Rating Level: 2 (Good)
Study Rundown: While pregnancy does put additional stress on the mother’s kidneys, current guidelines suggest that kidney transplant recipients may safely bear children after one year of good graft function without complications. Several studies have shown that pregnancy does not harm the transplanted mother, but few have analyzed outcomes of the resulting babies. This study compared the survival and characteristics of babies born to transplanted mothers to Australian national averages. Outcomes proved to be somewhat worse, with 87% of pregnancies resulting in live births (excluding terminations) compared to 99.3% in the general population. Among these, post-transplant babies were much more likely to be premature, have a lower mean live birth weight and have higher perinatal mortality. As advances in care allow transplanted mothers to have longer pregnancies, the resulting outcomes may improve. More thorough analysis of transplant management characteristics is warranted, as some of these might prove to be modifiable risk factors.
Relevant Reading: Changes in fertility and hormone replacement therapy in kidney disease
In-Depth [retrospective cohort study]: Data in the Australia and New Zealand Dialysis and Transplant Registry (1971-2010) and the National Perinatal Epidemiology and Statistics Unit (1991-2010) were used to identify 692 pregnancies in 447 transplant recipients, and 5,269,645 pregnancies nationally in Australia. Pregnant transplant mothers were a median of 31 years old, and were five years post-transplant; 42% had more than one pregnancy. Excluding terminations, live birth rate in post-transplant pregnancies increased from 81% (1971-80) to 88% (1980-2010), compared to 99.3% of national pregnancies. Each five-year increase in maternal age was associated with an odds ratio for live birth of 0.63 (95% CI: 0.47-0.86, p=0.003). Additionally, 54% of post-transplant babies were pre-term, compared to 7% nationally. Mean live birth weight was significantly lower in the post-transplant group (2485 vs 3358, p<.05). Neonatal mortality was found to be significantly higher in transplant mothers, 5% compared to a national rate of 0.3% (p<0.001), though this difference did not persist after adjusting for gestational age.
By Mariya Samoylova and Chaz Carrier
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