Abstract
To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil. Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, and maternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum. A total of 22 women had at least 1 pregnancy during the considered time interval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3 months. The most frequent complication during pregnancy was hypertension, which affected 11 (64.7%) women. The gestational age at delivery was 34.7 ± 4 weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy. Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.
Highlights
MethodsThe rise of hypertension and diabetes in recent years, along with other less prevalent causes, has increased the occurrence of chronic kidney disease (CKD), a progressive loss of renal function, classified in five stages, according to the glomerular filtration rate.[1]The prevalence of CKD in Brazil is of 1.5% and, currently, 3 to 6 million people live with this disease in the country, the majority of them untreated
A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes
The mean age at transplantation was of 25.0 Æ 4.0 years old, and the mean time interval until pregnancy was of 70.6 Æ 45.3 months
Summary
The rise of hypertension and diabetes in recent years, along with other less prevalent causes, has increased the occurrence of chronic kidney disease (CKD), a progressive loss of renal function, classified in five stages, according to the glomerular filtration rate.[1]. The prevalence of CKD in Brazil is of 1.5% and, currently, 3 to 6 million people live with this disease in the country, the majority of them untreated. There are $ 120 thousand patients on dialysis,[2] and > 92 thousand people already underwent renal transplantation in the country.[3]. CKD may impair fertility due to anovulatory cycles caused by hypothalamic-pituitary-axis dysfunction.[4] Fertility can be restored after renal transplantation with the improvement of kidney function.[5]. Obstetrics complications, such as hypertension, gestational diabetes mellitus, fetal growth restriction and preterm deliveries were observed in many previous studies.[5,6,7] One fifth of pregnancies ends as abortion; after the 1st trimester, most pregnancies present adequate development.[8]
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