Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Pregnancy after kidney transplantation in South Australian cohort over 39 years  (#16)

Fadak Mohammadi 1 2 , Matthew Borg 1 2 , Stephen McDonald 1 2 , Shilpa Jesudason 1 2
  1. Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  2. Central and Northern Adelaide Renal Transplantation Services, Royal Adelaide Hospital, Adelaide , South Australia, Australia

Aim: To report the maternal, obstetric and foetal outcomes of pregnancies in women after kidney transplantation, from a large transplanting unit in South Australia.

Background: Achieving parenthood for women with renal failure is facilitated by successful transplantation. However, these remain complex pregnancies, with higher rates of adverse outcomes than the general population.

Methods: We retrospectively reviewed pregnancies in South Australian transplanted women from 1976-2015.

Results: We identified 56 pregnancies in 35 women with mean age 30.5±4.2 years. Nearly 50% had no specific pre-pregnancy counselling. 

Foetal Outcomes: The overall live birth rate (LBR) was 79%, with 11% spontaneous losses, and 7% elective terminations. Pregnancies reaching ≥20 weeks (n=46) had LBR of 94%, with two intrauterine deaths. Intrauterine growth restriction occurred in 21.3%, with mean birth weight of 2520.6.3±674.1 grams. Growth scans in 20 pregnancies demonstrated median growth percentile progressively falling to 34%±14.5. The mean gestational age was 35.5±3.3 weeks, with preterm birth (<37 weeks) affecting 57% of babies.

Maternal Outcomes: Women with pre-pregnancy creatinine >110umol/L had a decline in renal function post-partum, higher rates of pre-eclampsia and babies with lower gestation and birth weight compared to those with pre-pregnancy creatinine <110umol/L (Table 1). 17 pregnancies required hospitalisation (other than for delivery), primarily with pre-eclampsia. Hypertensive disorders were common: chronic hypertension (22%), gestational hypertension (22%), and pre-eclampsia (28%). Pre-eclampsia prophylaxis (aspirin and calcium) was used in 3 pregnancies, where two still developed pre-eclampsia. Only 2 women had gestational diabetes. Caesarean section (CS) occurred in 61%; half of these were emergency CS. Only 12 patients breastfed.

Conclusions: While the LBR is encouraging, there remains a high risk of obstetric complications. Pre-pregnancy graft function and hypertension are likely drivers of adverse outcomes. Pre-conception counselling is crucial to avoid unplanned pregnancy in this high-risk cohort.