Pregnancy Outcomes Among Women With Kidney Allografts in Brazil: An Integrative Review

Chronic kidney disease can reduce fertility, but fertility may improve after transplant. Posttransplant pregnancy carries risks like preeclampsia, miscarriage, and prematurity. Although pregnancy is an immune-tolerant state, changes in immunosuppressive drugs during pregnancy can increase graft rejection risk. This study evaluated maternal and fetal outcomes in Brazilian kidney transplant recipients with post-transplant pregnancies.

We conducted an integrative review of articles from PubMed/Medline databases, analyzing study periods, study design, immunosup-pressive regimens, and the prevalence of preeclampsia and/or eclampsia, preterm births, pregnancy loss, graft rejection, and graft failure within 2 years after pregnancy.

Nine articles were included after we screened titles, abstracts, and full texts, covering studies from 1968 to 2019. Among studies, most patients received azathioprine and steroids, and cyclosporine was the most used calcineurin inhibitor. The overall incidence of preeclampsia was 26.3%. Rates of pregnancy loss varied, with losses higher with graft dysfunction, hypertension, and first-year pregnancies. Preterm birth exceeded 50% in most studies. Graft rejection was 4.7%, with most recipients maintaining functio-ning grafts at 2 years.

The incidence of preeclampsia in most studies included in this review were higher than those reported by other research, possibly due to inadequate control of comorbidities. Pregnancy loss observed in this study was similar to other studies, and overall graft rejection rate was also comparable, although causes of graft loss were not specified. The occurrence of preeclampsia in most studies of Brazilian transplant pregnancies was higher than in other studies. Other maternal and fetal outcomes were similar to those previously reported.