Abstract
BackgroundKidney transplant improves reproductive function in women with end-stage kidney disease. Little is known about contraceptive use in women with history of kidney transplants.MethodsUsing data from the United States Renal Data System, we evaluated for each calendar year women with kidney transplantation between 1/1/2005 and 12/31/2013 who were aged 15–44 years with Medicare as the primary payer and linked data from the United Network for Organ Sharing, for up to three entire years after the date of transplantation. We determined rates of contraceptive use and used multivariable logistic regression to identify factors associated with contraceptive use.ResultsThe study cohort included 13,150 women and represented 26,624 person-years. The rate of contraceptive use was 9.5%. Compared to women aged 15–24 years, contraceptive use was lower in women aged 30–34 years (OR 0.67; CI 0.58–0.78), 35–39 years (OR 0.36; CI 0.31–0.43), and 40–44 years (OR 0.23; CI 0.19–0.28). Compared to white women, contraceptive use was higher both in black women (OR 1.26; CI 1.10–1.43) and Native American women (OR 1.52; CI 1.02–2.26). Women had lower rates of contraceptive use in the second-year post-transplant (OR 0.87; CI 0.79–0.94) and the third-year post-transplant (OR0.69; CI 0.62–0.76) than in the first-year post-transplant. Women with a history of diabetes had a lower likelihood of contraceptive use (OR 0.80; CI 0.65–0.99).ConclusionAmong women with kidney transplants, contraceptive use remains low at 9.5%. Factors associated with a higher likelihood of contraceptive use include younger age and black and Native American race/ethnicity; and second- and third-year post-transplant. The history of diabetes is associated with a lower likelihood of contraceptive use. The study highlights the need of increasing awareness for safe and effective contraceptive use in women with kidney transplants.
Highlights
End-stage kidney disease (ESKD) adversely impacts fertility, there is a return of reproductive function following a kidney transplant, and conception is common [1, 2]
Using a national registry of patients with end-stage kidney disease (ESKD), we found that contraceptive use rates increased in the last decade, overall contraceptive use was low at 9.5% among women during the first three years after receiving a kidney transplant
Race/ethnicity, ESKD cause, year of conception posttransplant, history of diabetes, and Glomerular filtration rate (GFR) were important factors associated with contraceptive use in the current study
Summary
End-stage kidney disease (ESKD) adversely impacts fertility, there is a return of reproductive function following a kidney transplant, and conception is common [1, 2]. History of kidney transplant increases the risk of adverse pregnancy outcomes, including pre-eclampsia, gestational hypertension, low birth weight babies, and preterm births [3, 4]. Provision of safe and effective contraception should be readily available especially to women with kidney transplants who take teratogenic medications like mycophenolate mofetil, and who wish to delay or avoid pregnancy. Women had lower rates of contraceptive use in the second-year post-transplant (OR 0.87; CI 0.79–0.94) and the third-year post-transplant (OR0.69; CI 0.62–0.76) than in the first-year post-transplant. Women with a history of diabetes had a lower likelihood of contraceptive use (OR 0.80; CI 0.65–0.99). Factors associated with a higher likelihood of contraceptive use include younger age and black and Native American race/ethnicity; and second- and thirdyear post-transplant. The study highlights the need of increasing awareness for safe and effective contraceptive use in women with kidney transplants
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