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Meta-Analysis
. 2019 Jan 23;20(1):24.
doi: 10.1186/s12882-019-1213-5.

Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review

Silvi Shah  1 , Renganathan Lalgudi Venkatesan  2 , Ayank Gupta  2 , Maitrik K Sanghavi  2 , Jeffrey Welge  3 , Richard Johansen  2 , Emily B Kean  2 , Taranpreet Kaur  4 , Anu Gupta  5 , Tiffany J Grant  2 , Prasoon Verma  6
Affiliations
Meta-Analysis

Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review

Silvi Shah et al. BMC Nephrol. .

Abstract

Background: Reproductive function in women with end stage renal disease generally improves after kidney transplant. However, pregnancy remains challenging due to the risk of adverse clinical outcomes.

Methods: We searched PubMed/MEDLINE, Elsevier EMBASE, Scopus, BIOSIS Previews, ISI Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials from date of inception through August 2017 for studies reporting pregnancy with kidney transplant.

Results: Of 1343 unique studies, 87 met inclusion criteria, representing 6712 pregnancies in 4174 kidney transplant recipients. Mean maternal age was 29.6 ± 2.4 years. The live-birth rate was 72.9% (95% CI, 70.0-75.6). The rate of other pregnancy outcomes was as follows: induced abortions (12.4%; 95% CI, 10.4-14.7), miscarriages (15.4%; 95% CI, 13.8-17.2), stillbirths (5.1%; 95% CI, 4.0-6.5), ectopic pregnancies (2.4%; 95% CI, 1.5-3.7), preeclampsia (21.5%; 95% CI, 18.5-24.9), gestational diabetes (5.7%; 95% CI, 3.7-8.9), pregnancy induced hypertension (24.1%; 95% CI, 18.1-31.5), cesarean section (62.6, 95% CI 57.6-67.3), and preterm delivery was 43.1% (95% CI, 38.7-47.6). Mean gestational age was 34.9 weeks, and mean birth weight was 2470 g. The 2-3-year interval following kidney transplant had higher neonatal mortality, and lower rates of live births as compared to > 3 year, and < 2-year interval. The rate of spontaneous abortion was higher in women with mean maternal age < 25 years and > 35 years as compared to women aged 25-34 years.

Conclusion: Although the outcome of live births is favorable, the risks of maternal and fetal complications are high in kidney transplant recipients and should be considered in patient counseling and clinical decision making.

Keywords: Fetal; Kidney transplant; Maternal; Outcomes; Pregnancy.

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All the authors have no disclosures and competing interests. The results presented in this paper have not been published previously in whole or part, except in abstract format.

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Figures

Fig. 1
Fig. 1
Study cohort showing the selection of studies reporting outcomes of pregnancies in women with kidney transplant
Fig. 2
Fig. 2
Forest Plot showing outcome of live births among kidney transplant recipients overall, and across different geographical regions
Fig. 3
Fig. 3
Forest Plot showing outcome of miscarriages among kidney transplant recipients overall, and across different geographical regions
Fig. 4
Fig. 4
Forest Plot showing outcome of induced abortions among kidney transplant recipients overall, and across different geographical regions
Fig. 5
Fig. 5
Forest Plot showing outcome of still births among kidney transplant recipients overall, and across different geographical regions
Fig. 6
Fig. 6
Forest Plot showing outcome of ectopic pregnancies among kidney transplant recipients overall, and across different geographical regions
Fig. 7
Fig. 7
Forest Plot showing outcome of preeclampsia among kidney transplant recipients overall, and across different geographical regions
Fig. 8
Fig. 8
Forest Plot showing outcome of cesarean section among kidney transplant recipients overall, and across different geographical regions
Fig. 9
Fig. 9
Forest Plot showing outcome of gestational diabetes among kidney transplant recipients overall, and across different geographical regions
Fig. 10
Fig. 10
Forest Plot showing outcome of pregnancy induced hypertension among kidney transplant recipients overall, and across different geographical regions
Fig. 11
Fig. 11
Forest Plot showing outcome of preterm births among kidney transplant recipients overall, and across different geographical regions
Fig. 12
Fig. 12
Forest Plot showing outcome of neonatal mortality among kidney transplant recipients overall, and across different geographical regions
Fig. 13
Fig. 13
Forest Plot showing rates of acute rejection among kidney transplant recipients overall, and across different geographical regions
See this image and copyright information in PMC

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