Outcome of pregnancy following renal transplantation

Abstract

Fertility is restored following renal transplantation, and the potential for motherhood can be realised. This retrospective study reviews the outcome of 53 pregnancies, in 24 patients, between 1988 and 1995. All patients underwent transplant surgery, and received antenatal care at a single centre. The mean age at first conception was 27.6 years, and graft function, as assessed by serum creatinine at the time of antenatal booking, was good. Patients were referred early, seen regularly, and had both obstetrician and nephrologist involved in management. The main maternal complication was hypertension, affecting 50% of patients. Seven patients had a worsening of pre-existing hypertension, whilst four patients developed hypertension for the first time during pregnancy. Graft function was, for the most part, well maintained. Four patients required delivery because of declining renal function, two of these went on to develop frank rejection, necessitating a return to dialysis within 3 months of delivery. These figures however are not higher than have been reported in the non-pregnant population. The overall pregnancy loss was 26%. There were a total of 39 live births. Premature birth was higher than that of the general population, with 57% of infants in the study delivering before 37 weeks' gestation (average 34 weeks' gestation) Of the 39 infants born alive 27% were growth retarded. Congenital abnormalities were, reassuringly, no higher than that in the general population, despite the need to take immunosuppressive drugs. Delivery was by caesarean section in 64% of cases, which may reflect a high degree of clinical caution in this group of patients. The study concludes that, whilst risks are recognised, for both the mother and infant, with a careful, multidisciplinary approach, the outcome is generally good.