**2. Status of pregnancy related issues in country**

The 2006-07 Pakistan Demographic and Health Survey (PDHS) was undertaken to address the monitoring and evaluation needs of maternal and child health and family planning programs. In 1992-96 marital fertility; reported as 7.6 children per married woman, with a decline of one child over the past decade, PDHS data 2006-2007 reports 6.6 children per married woman. Eight percent of ever-married women report that they had a miscarriage in the past five years; about 2 percent said they had an abortion, and 3 percent reported having a stillbirth. For the most recent five-year period preceding the survey, infant mortality is 78 deaths per 1,000 live births. In interpreting the mortality data, it is useful to keep in mind that sampling errors are

© 2013 Naqvi; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

quite large. For example, the 95 percent confidence intervals for the under-five mortality esti‐ mate of 94 per 1,000 are 86 and 103 per 1,000 indicating that, given the sample size of the 2006-07 PDHS, the true value may fall anywhere between 86 and 103 per 1,000 births. As observed in most studies, the mother's level of education is strongly linked to child survival. Higher levels of educational attainment are generally associated with lower mortality rates because educa‐ tion exposes mothers to information about better nutrition, use of contraceptives to space births, and knowledge about childhood illness and treatment. Similarly, childhood mortality rates decline as the wealth quintile increases. Only 34 percent of births in Pakistan take place in a health facility. Eleven percent is delivered in a public sector health facility and 23 percent in a private facility. Three out of five births (65 percent) take place at home. (Pakistan Demo‐ graphic and Health Survey 2006-07, National Institute of Population Studies Islamabad, Paki‐ stan. Macro International Inc. Calverton, Maryland USA, published June 2008)

to have been able to pass a viable and authentic transplant law and activity of unrelated donor transplant decreased. Deceased donor transplant yet has to take off in country, though few have been done from non heart beating donors, organs supplied by Euro-transplant founda‐

Pregnancy Post Transplant http://dx.doi.org/10.5772/54805 279

Female with ESRD have hypothalamic-pituitary-gonadal dysfunction, associated with high follicle stimulating hormone, luteinizing hormone and prolactin levels. Ovulation is sup‐ pressed and mensturation is irregular. Additionally there is sexual dysfunction, suppressed desire and associated psychological factors resulting from chronic ailment. Women on dialysis if conceive present with challenges of worsening of blood pressure controls and anemia, and higher incidences or pre-eclampsia. In 1980, the European Dialysis and Transplant Association reported that only 23% of 115 pregnancies in dialysis ended with surviving infants (European Registry). In 1998, Bagon et al. described a national survey showing a successful outcome in approximately half of the pregnancies in dialysis patients. There are few case series in the new millennium, mainly from single experienced centers, many of which report a successful out‐ come rate of >70% (Romao 1998, Barua 2008). Our own experience is limited with very poor

Reversal of normal endocrine function has been reported within 4-6 months after renal trans‐ plantation. (Ha 1991, Ghafari 2008, McKay 2008) Thus kidney transplant offers best hope for ESRF patients who keen to conceive. First pregnancy in renal transplant recipient was reported by Murray in 1963, since then there are many published reports focusing on impact of preg‐ nancy on renal graft outcome with a conclusion that pregnancy does not have an adverse effect on graft function provided recipient has stable graft function and no adverse event happens

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‐

**4. End Stage Renal Disease (ESRD) affecting fertility**

tion and five local deceased donors.

outcome. (Unpublished)

during pregnancy. (Table)

aged by multidisciplinary team.

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

**5. Pregnancy post transplant**

The incidence of low birth weight (defined <2.5 Kg by WHO) in general population reported as high as 31% from South Asia (Badshah, 2008) and 33.9% reported from West Bengal, India. (Pahari 1997)
