Abstract
Pregnancy is not contraindicated in kidney transplant women but entails risks of maternal and fetal complications. Three main conditions can influence the outcome of pregnancy in transplant women: preconception counseling, maternal medical management, and correct use of drugs to prevent fetal toxicity. Preconception counseling is needed to prevent the risks of an unplanned untimely pregnancy. Pregnancy should be planned ≥2 years after transplantation. The candidate for pregnancy should have normal blood pressure, stable serum creatinine <1.5 mg/dL, and proteinuria <500 mg/24 h. Maternal medical management is critical for early detection and treatment of complications such as hypertension, preeclampsia, thrombotic microangiopathy, graft dysfunction, gestational diabetes, and infection. These adverse outcomes are strongly related to the degree of kidney dysfunction. A major issue is represented by the potential fetotoxicity of drugs. Moderate doses of glucocorticoids, azathioprine, and mTOR inhibitors are relatively safe. Calcineurin inhibitors (CNIs) are not associated with teratogenicity but may increase the risk of low birth weight. Rituximab and eculizumab should be used in pregnancy only if the benefits outweigh the risk for the fetus. Renin–angiotensin system inhibitors, mycophenolate, bortezomib, and cyclophosphamide can lead to fetal toxicity and should not be prescribed to pregnant women.
Highlights
Since persons on immunosuppressive medications are at increased risk for severe COVID-19, it is recommended that those people may receive a COVID-19 vaccine along with counseling that the vaccine safety and efficacy profiles are unknown, and there is a potential for reduced immune responses [26]
Oral labetalol and methyldopa are most used, and second-line agents include clonidine and calcium channel blockers [36,37]. Both angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are contraindicated in pregnancy because single-center reports and meta-analyses revealed a significant association between overall congenital malformations and first trimester exposure to ACEI/ARBs
Some investigators prefer to increase the doses of Calcineurin inhibitors (CNIs), but the is no evidence that lower blood levels reflect the intracellular concentration of CNI [62]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In most women with successful kidney transplantation, fertility is spontaneously restored within a few months, resulting in normal ovulatory cycles and regular menstruation [1,2,3]. This offers a chance for transplanted women to have children. Pregnancy can be a reasonable option for women with a good function of the kidney transplant. A meta-analysis and systematic review of 6712 pregnancies in 4174 kidney transplant recipients reported that the live-birth rate was 72.9%. The main potential issues of pregnancy in kidney transplantation will be discussed. Particular attention will be focused on three main topics: the counseling on contraception, the maternal medical management during pregnancy, and the choice of immunosuppressive drugs to prevent fetal toxicity
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