Pregnancy in kidney transplanted women: what are the optimal conditions for a better pregnancy outcome?

BACKGROUND: Motherhood has long been not recommended for kidney transplanted women for fear of adverse effects on the graft and the risks to the fetus.

AIMS: This article aimed to provide evidence based answer to the following questions regarding pregnancy in kidney transplanted women: 1. what are the nephrologic and obstetrical parameters that can influence the pregnancy outcome? 2. What is the impact of pregnancy on graft? 3. What are the optimal conditions for pregnancy planning in kidney transplanted women?

METHODS: A literature search was conducted using as key words "pregnancy", "renal transplant", "renal graft survival" in the PubMed database over the period from January 1994 to December 2011.

RESULTS: Recovery of renal function in kidney transplanted patients is followed by restoration of endocrine function. Knowledge of the initial nephropathy assesses the risk of recurrence after transplantation, which may affect the graft. Chronic glomerular nephropathies are the most frequent from 32 to 76.1%. Duration of hemodialysis (over 2 years) is associated with a risk of preterm delivery and growth retardation. A period of 1 year between renal transplantation and conception seems reasonable to stabilize renal function and reduce the doses of immunosuppressants. The number of unintended pregnancies remains high (50%). The incidence of pregnancy after renal transplantation varies between 3 and 21.2%. Graft survival in patients who carried a pregnancy is equivalent to that of patients who were not pregnant.

CONCLUSIONS: Pregnancy in kidney transplanted patients is a highrisk pregnancy, but it does not seem to affect graft function through certain conditions.