More and more women of childbearing age are having kidney transplants and pregnancies in this group are increasing. There can be special risks. Here is an up-to-date survey of the problem.
In any discussion of kidney disease in the U.S., it is important to remember that this country has a notorious overconsumption of analgesics (pain-killers). This is the basic reason for at least 15 percent of kidney transplants performed here – a salutary warning to women who regularly use pain-killing tablets and powders.
Because of kidney disease, many women who want to bear children cannot do so. Kidney disease is a well-known cause for the inability to conceive.
An enormous number of kidney transplants have taken place successfully, and about 80 percent of those with successful grafts manage to go back to their normal duties, whether outside jobs or household chores.
But, as successful transplant operations increase, a new problem has arisen. More and more women of childbearing age are having diseased kidneys replaced by healthy ones. What happens if they become pregnant?
Women who have undergone kidney transplants have a far greater chance of becoming pregnant than those on dialysis, a procedure in which the blood is regularly purified by a machine. Dialysis is a lengthy, time-consuming business. But it works, and enormous numbers of women use the system in the U.S.
However, the chances of becoming pregnant on dialysis are slim. Indeed, according to the European Dialysis and Transplant Association, only 53 patients on dialysis have become pregnant. This equals about one for every 200 women of childbearing age on dialysis.
At least half of these pregnancies end in miscarriage. Most others are legally terminated. Three living infants have been born, and one of these had severe congenital abnormalities, the British Medical Journal reported recently.
Women who have undergone kidney transplants, however, have a far greater chance of becoming pregnant than those on dialysis. Fertility is improved after a transplant. Indeed, many women on dialysis request transplants in order that they should become pregnant and raise a family.
The European Dialysis and Transplant Association reports 66 pregnancies among women with transplanted kidneys. This is about one for every 50 women of childbearing age with a functioning kidney transplant.
The results of these pregnancies have been encouraging. Of the 66 women, only 15 had miscarriages (far fewer than the figure of 50 percent for those under dialysis).
Thirty-two of the 66 pregnancies were terminated for medical reasons, but to the remaining 19 women live infants were born, none of whom had any congenital abnormalities.
However, the pregnancies were not all plain sailing as most of the mothers-to-be rapidly discovered.
First, early diagnosis of pregnancy is far more difficult in a kidney patient. Elevated blood pressure is a common complication, and appropriate drug medication is essential. Also, immunosuppressive therapy is often essential throughout pregnancy to make certain the kidneys keep operating.
With the current view that drug therapy of any kind is simply “not on” during pregnancy (especially during the first three months) for normal patients, it is surprising that congenital abnormalities from adverse drug effects did not occur in any of the 19 reported successful pregnancies.
Infections are always a hazard with transplant patients, and the risk is even greater during pregnancy.
In some of the women, the transplanted kidney presented an obstruction to normal vaginal delivery. So cesarean sections were necessary. This again added to the risk. In several cases, premature labor occurred – and this increases the risk to the infant.
The British Medical Journal, discussing the total picture, commented:
There are many substantial arguments against pregnancy in a kidney transplant patient, and valid reasons for termination. There are risks to the patient, a reduced likelihood of a successful outcome, and the chance the patient may not survive. But, once advised, the patient must make her own decision.
Success depends on co-operation and teamwork between the kidney specialist, the obstetrician, and finally the child specialist to a nothing of the patient herself, plus her husband.
A recent report in the Journal of the American Medical Association suggests that American results have been better than Europeans. At the Prentice Women’s Hospital in Chicago, 17 pregnancies occurred in 12 transplant patients.
Twelve babies were born. Three were smaller than normal, two larger, and the rest quite normal. One woman gave birth to twins and later to a single baby. Unfortunately, fate did not continue to be kind to her for she died from hepatitis some months later.
Another survey carried out in North America reported 103 women becoming pregnant after kidney transplants. Seventy-six patients gave birth to 86 normal children, 42 of these being delivered by cesarean section. There were nine spontaneous (natural) and 22 induced abortions (three on purely medical grounds).
So, the picture is an encouraging one. No longer are women with kidney disease doomed, as was once believed. The outlook is bright.