**7. Risks for mother**

**Author year Duration Country No. of**

280 Current Issues and Future Direction in Kidney Transplantation

Cararach 1993 25 years Spain 133 Abortions 10%

First 1995 23 years USA 25 Abortions 3

Saber 1995 25 years Brazil 25 Abortions 4

Tan 2002 14 years Singapore 42 Abortions 10

Armenti 2004 14 years USA NTPR 1125 Abortions 20%

Kashanizadeh 2007 6 years Iran 86 Abortions 24

Pregnancy Registry

Countries

Naqvi 2010 24 years Pakistan 68 Abortions 15

Sibanda 2007 7 years UK Transplant

Draihimh 2008 10 years 5 Middle East

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

Sturgiss 1996 23 years UK 18 (compared with

**pregnancies reported**

18 non pregnant controls)

**outcome**

Preterm 46% Full Term 53%

Live births 22

Preterm 14 Full term 7

Still birth 1 Ectopic 2

Still births 2.5% Ectopic 1%

Full term 62

Still births 7.3% Live births 74.4%

Preterm 8

FSB)

Full term 45 (40 live, 5 IUD or

IUDs 3 Ectopic 1 Live Births 149

193 Abortions 32

234 Abortions 19.3%

Premature births 53%

Long term graft survival compared in two groups. 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 week of gestation. Poorly controlled hypertension can cause preterm delivery.

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 reported as high as 42%. (Oliveria 2007)

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

Other infections that may pose additional risks in the immunosuppressed mother include toxoplasmosis, primary herpes simplex infection, primary varicella infection, HIV infection, and infection with either hepatitis B or C virus (Gardella 2007, Shiono 2007)

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)
