حاملگي پس از پيوند كليه در مركز پيوند كليه دانشگاه علوم پزشكي كرمانشاه

Pregnancy after kidney transplantation. A survey in renal transplantation center of Kermanshah University of Medical Sciences

Background and Aim: Women with chronic renal failure can resume normal fertility after Kidney transplantation. However, in such pregnancies, potential risks of immunosuppressive agents on pregnancy status and fetus should be taken into consideration. There are some reports indicating fetal malformations, preterm labour, abortion and intrauterine growth retardation in such pregnancies. The present study was designed to evaluate the status of pregnancy in women with kidney transplantation in Renal Transplantation Center of the 4th Shahid Mehrab Hospital in Kermanshah. Materials and Methods: This was a descriptive-analytic study and the medical records of women who had pregnancy after renal transplantation during 1368-1378 were reviewed. Necessary data concerning the serum creatinine level, blood pressure during pregnancy, age at the time of pregnancy, interval between transplantation and child-birth and occurrence of acute allograft rejection during pregnancy were collected. The newborns were examined twice in a 6 month interval for physical growth, developmental status and major malformations. Results: 11 pregnancies occurred in 9 women with kidney transplantation, , but one case led to abortion (9%). Immunosuppressive therapy consisted of cyclosporin A and steroid in 3 cases (30%), and cyclosporin A, steroid and azathioprine in 7 cases (70%). The time interval between transplantation and childbirth was 24.6±15.67 months, and the mean age of mothers during pregnancy was 27.22±5.74 years. There was no significant difference between mean systolic and diastolic blood pressures and serum creatinine level before and during pregnancy. There was no acute allograft rejection or any other remarkable problems during pregnancy. Only four newborns, 3 boys and one girl were brought for follow up. 3 cases of pregnancies were unwanted and only one case was intentional. The mean weight of the newborns was 2.62±0.47 Kg, and one of them was underweight (25%). Physical growth and development of these newborns were normal and there was no obvious congenital malformation. Conclusion: Although immunosuppressive agents can cross placental barrier and expose mother and fetus to potential risks, this study like other recent studies revealed that supportive measures before pregnancy and close monitoring of the pregnant women by an experienced and multidisciplinary team, may lead to the birth of a healthy baby, without any adverse effect on the function of the allograft.