Pregnancy after kidney transplantation: effect on maternal and foetal health

Abstract

Background. Pregnancy in kidney transplant recipients is high-risk due to immunosuppression, pre-existing comorbidities, and graft function concerns. Optimal maternal and foetal outcomes require a multidisciplinary approach and favourable baseline conditions. Objective: to identify ideal conditions for pregnancy in kidney transplant recipients and evaluate the impact of pregnancy on maternal and graft outcomes. Materials and methods. It was the retrospective observational study conducted at the Department of Obstetrics and Gynaecology of the Institute of Kidney Diseases and Research Centre (Ahme­dabad, India) from 2014 to November 2020. A total of 27 pregnancies in kidney transplant recipients were analysed. Maternal nephrological parameters, obstetric complications, and graft function were assessed during and after pregnancy. Key outcomes measured included time between renal transplantation and conception, live birth rate, maternal renal function, and neonatal health. Data were collected from clinical records and analysed retrospectively. Results. The primary outcomes were the interval between renal transplantation and conception, live birth rate, and maternal renal function pre- and post-pregnancy. The mean age at transplantation was 28.70 ± 3.82 years, and the mean age at conception was 31.07 ± 2.57 years. The average time between transplantation and conception was 47 months. Median serum creatinine was 1.13 ± 0.39 mg/dL at conception and 1.09 ± 0.45 mg/dL postpartum. Sixteen pregnancies (59 %) resulted in live births. Common complications included preeclampsia (6 cases, 22.22 %), preterm delivery (16 cases, 59 %), and low birth weight (9 cases, 33.33 %). Caesarean section was performed in 14 patients (52 %). Conclusions. Pregnancy in kidney transplant recipients is feasible under strict monitoring and does not significantly affect graft function when optimal conditions are met. Outcomes are influenced by ade­quate pre-pregnancy renal function, stable immunosuppressive therapy, and multidisciplinary care.