It is not recommended for a renal transplant patient to become pregnant after transplantation but it can be done successfully as long as the future mom is aware of the risks. According to a study published in the American Journal of Transplantation, pregnancy after kidney transplant is associated to higher live birth rate, lower miscarriage but more complications than the general US population. I would have never thought that kidney transplant patient could have babies with relatively good outcome.
Dark Side of the Story
Despite having relatively good outcome with pregnancy, renal transplant patients should discuss the risks with their nephrologists. It is not all kidney transplant physician who will support their patients idea to have a baby. They also need to find an OB/GYN willing to take high-risk pregnancy patients because the follow up will need to be tight. Despite having more babies delivered by percentage than the general population, the complication rate is much higher. These complications need to be addressed before the pregnancy to improve outcome.
There is 6 times more chance for preeclampsia (high blood pressure and protein in urine) in women with history of kidney transplant. Some of the risk factors of preeclampsia that are related to a post renal transplant patient are kidney disease and vitamin D deficiency. This condition can lead to eclampsia if left untreated and can be fatal for both mom and baby.
Another complication that is not as bad but still need to be considered is gestational diabetes. The chance of having this complication is double the rate of a pregnant woman with no history of renal transplant. Because most transplant patients take prednisone as immune suppressant, diabetes rate is higher to begin with. Like all transplant patients know, prednisone is well known to increase blood sugar level. The complications for this kind of diabetes (it mostly affects baby)are: excessive birth weight, jaundice, respiratory distress, higher risk of diabetes type 2 later in life.
More than half of the renal transplant patients having babies have them through a C-section versus one third of all pregnant women. Any surgery after organ transplant has more risk than for anybody else. C-section brings its share of complications such as infection, blood clot in legs, bleeding. If a transplant patient is taking rapamune, it will have to be stopped ahead of time because that drugs delay wound healing. Anytime there is a change in a successful immune suppression regimen there are risks for rejections. The decision on how to have the baby should be discussed with the physicians ahead of time so the risks and benefits are well understood.
Pregnancy after organ transplantation should always be discussed with your transplant physician before the baby is conceived. Having a baby is a lifelong commitment and that should always be kept in mind.