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Background: Fertility typically returns after kidney transplantation; however, pregnancy in this population remains high-risk. Although most result in live births, rates of fetal complications including preterm birth, low birth weight, fetal growth restriction (FGR), and cesarean delivery are significantly elevated, especially among individuals of advanced maternal age. Pregnant kidney transplant recipients also experience higher rates of preexisting hypertension and pre-eclampsia compared to the general obstetric population. Furthermore, pregnancy following solid organ transplantation may increase the risk of graft dysfunction or rejection due to immunologic complications. Limited data exists on pregnancy outcomes in this group. This study provides a descriptive statistical analysis of a small cohort of women who became pregnant following kidney transplantation.
Methods: Data were collected from 17 women who became pregnant after renal transplantation (5.9% White, 41.2% Black, 47.1% Hispanic, 5.9% Asian). Participants lived in areas with limited neighborhood resources (mean Area Deprivation Index = 75%, SD = 20.8). The average time from transplant to delivery was 8.2 years. Exploratory descriptive statistics and correlation analyses were performed to examine risk factors and outcomes before and after transplant, as well as pre/peri/post pregnancy, in relation to medical and social determinants of health.
Results: Relevant significant positive correlations were found between Body Mass Index (BMI) at the time of transplant and during the first and second trimesters, and serum creatinine levels measured one month before pregnancy, at conception, and at the end of the first trimester. Additionally, longer duration on dialysis prior to transplant was associated with lower neighborhood resource access.
Conclusions: This exploratory study provides insights into a unique sample of women who pursued pregnancy following renal transplant at a large urban public medical center. Findings of this study provide insights into relevant risk factors and considerations for optimizing pregnancy and graft outcomes in this high-risk population.
