Special Conditions

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Pregnancy after Kidney Transplant

Introduction

One of the benefits of a successful kidney transplant is the ability of the women to become pregnant. Increased levels of urea in blood (uremia) due to improper functioning of the kidneys can cause ovulation (release of the egg from the ovary) to stop. As a result women have problem in conceiving. Kidney transplantation can help in correcting this uremic state and thereby help the women to become pregnant.

Although pregnancy after kidney transplant may have risks to the mother and the baby many women have become pregnant and delivered healthy children after a kidney transplant. However, it is advisable to avoid pregnancy for at least 1-3 years following transplant operation as this is the time when most of the complications occur and the medication dosage is also high.

Planning pregnancy

Although the decision to have a child is personal one it is advisable to consult your doctor before planning your pregnancy to avoid any untoward complications.  When planning pregnancy following points should be taken care of:

  • Kidney function should be stable with serum creatinine levels of less than 2 mg/dl.
  • Blood pressure should be normal or under adequate control with treatment.
  • Dose of immunosuppressive drugs should be at a lower level.
  • If you are taking Mycophenolate Mofetil(orCellcept), consult your doctor as it can increase the risk of birth defects.

Risk to the mother and the baby

Although successful pregnancies have been reported after kidney transplant, however there may be some risk to the mother and the baby. Pregnancy in a transplant patient is considered to be a “high risk pregnancy”.

  • Risk to the mother include:

o    High blood pressure with protein in urine is seen in 30% of cases.

o    Decrease in kidney function may be seen in approximately 10% of cases.

o    Impairment in kidney function can lead to:

o    increased risk of pre-eclampsia

o    premature delivery

o    less chances of spontaneous delivery and increased incidence of cesarean delivery

  • Risk to the baby include:

o    Low birth weight.

o    Birth defects in 5% of cases where mother has had a transplant and 4% in fathers who have had a transplant.

Effect of immunosuppressant drugs on baby

  • Taking Cyclosporin (in maintenance doses) does not increase the risk of newborn complications or birth defects.
  • Prednisone and Azathioprine are also safe during pregnancy.
  • Mycophenolate mofetil has been associated with some abnormalities, hence in women with stable kidney function this drug should be replaced with Azathioprine.
  • Even men taking standard doses of the above three drugs have fathered children safely.
  • Breast feeding is to be avoided by transplant recipient mothers.

Effect of pregnancy on transplanted kidney

If the kidney function is stable before pregnancy there is usually no adverse effect on the transplanted kidney. Rejection or damage to the new kidney may be seen if the patient has pre-existing unstable kidney function. To minimize the risk of rejection episode it is best to plan pregnancy once 2 years have passed after transplant or last rejection episode. Hence to prevent the rejection of new kidney it is essential to:

  • Have a stable kidney function before pregnancy.
  • Monitor the cyclosporine levels in blood.
  • Monitor serum creatinine during pregnancy.

Therefore, to have a successful pregnancy after kidney transplant it is essential to plan your pregnancy in consultation with your doctor and be regular with the scheduled follow-up visits and check-ups.