**6. Optimal timing for pregnancy post transplant**

Most transplant centers advise that women can conceive after 2 years of transplant provided graft function is stable i.e. serum creatinine is < 1.5 mg/dl and proteinuria <500 mg/day. At that time, risk of acute rejections generally low, immunosuppression has reduced to minimal, prophylactic anti bacterial and anti viral already completed and women are usually stable. All pregnancies should be considered as high risk and should be man‐ aged by multidisciplinary team.


**7. Risks for mother**

reported as high as 42%. (Oliveria 2007)

**8. Risks to fetus**

is feeding to infant. (del Mar Colon 2007, Ross 2006)

Kg, with 7 newborns <1.8 Kg. (Naqvi 2010)

Mothers who are renal transplant recipient have certain risks on graft function and survival. Many of renal transplant recipients have hypertension and some degree of renal dysfunction with GFR (Glomerular filtration rate) of not up to the mark, both are affected with pregnancy and blood pressure medications may require alterations and increment in dosages. Some may predispose to pre-eclampsia which is difficult to diagnose especially when few of these women already have some preexisting proteinuria and blood pressure frequently increases after 20th

Pregnancy Post Transplant http://dx.doi.org/10.5772/54805 281

Women with preexisting graft dysfunction i.e. serum creatinine of > 1.5 mg/dl are at greater risk of developing irreversible worsening of graft function. (Davison 1976) Acute rejection can also occur as blood levels of immunosuppressant may alter with changing volume distribution during pregnancy, this phenomenon is more relevant with calcineurin inhibitors.(Donaldson 1996) However, available reports indicate that rejection rate in pregnant recipient not differ from non pregnant recipients. (Armenti 2004) In our experience of 68 pregnancies in renal transplant recipients, none experienced acute rejection during pregnancy. (Naqvi 2010)

Urinary tract infection rate also increases in pregnant renal transplant recipients, some have

The transplant recipient is at increased risk for viral infections, therefore, maternal–fetal trans‐ mission of infectious agents needs to be considered as a potential risk not only to the mother but also to the fetus. Cytomegalovirus infection is particularly serious because it is associated with hearing/vision loss and mental retardation and can be transmitted from the mother to the fetus through a trans-placental route, as well as during delivery or in breast milk in case mother

Other infections that may pose additional risks in the immunosuppressed mother include toxoplasmosis, primary herpes simplex infection, primary varicella infection, HIV infection,

As allograft recipients have increased risk for gestational diabetes, some have recommended that they should be screened every trimester with a 50-g oral glucose load. (del Mar Colon 2007)

Published reports from UK, USA and European registries persistently highlighted risk of low birth weight of fetus and pre term delivery in renal transplant recipients. (Sibanda 2007, Ar‐ menti 2004) Willis et al from Australia reported 44% with low birth weight. (Willis 2000) In our experience we found mean birth weight infants born to transplant recipients was 2.4± 0.57

Exposure to immunosuppressants: Adrenal insufficiency and thymic hypoplasia have occa‐ sionally been described in the infants of transplant recipients, but these problems are unlikely

and infection with either hepatitis B or C virus (Gardella 2007, Shiono 2007)

week of gestation. Poorly controlled hypertension can cause preterm delivery.

**Table 1.** Published results from world over
