# Pregnancy-related maternal and fetal outcomes following renal transplantation: a decade of experience at a tertiary care center in Saudi Arabia

## TL;DR

This study examines pregnancy outcomes in women who received kidney transplants in Saudi Arabia, finding that while risks exist, many pregnancies result in successful births with proper care.

## Contribution

The study provides insights into maternal and neonatal outcomes of pregnancies following kidney transplantation in a Saudi population over a decade.

## Key findings

- Most patients showed recovery in renal function post-delivery, though 21% had persistent impairment.
- Cesarean sections were common (74%), mainly due to fetal distress.
- Neonatal intensive care was required for 26% of infants, with a 3% rate of congenital anomalies.

## Abstract

Advancements in immunosuppressive therapy and transplant care have made pregnancy increasingly feasible for women with renal transplants. We aim to evaluate maternal and neonatal outcomes of pregnancies in kidney recipients followed up at a tertiary care center in Saudi Arabia.

A retrospective analysis was performed of women with kidney transplants who became pregnant between 2012 and 2021. Maternal demographics, transplant characteristics, immunosuppressive regimens, renal function parameters, pregnancy complications, and neonatal outcomes were assessed.

A total of 37 pregnancies in 35 kidney transplant recipients were evaluated with 2 resulting in miscarriage. The majority of transplants originated from living (88%) and related (87%) donors. Pre-pregnancy labs showed anemia in 26%, elevated creatinine (> 90 µmol/L) in 23%, eGFR < 60 mL/min/1.73 m² in 17%, and proteinuria in 26%. All patients had normal platelets and liver function tests, with a mean tacrolimus level of 7.4 ± 2.6 ng/mL. At the time of labor, the proportion of patients with anemia increased to 66%, while abnormal white blood cell counts and thrombocytopenia were observed in 15% and 21% of patients, respectively. Elevated creatinine (> 90 µmol/L) was present in 43%, eGFR < 60 mL/min/1.73 m² in 40%, and proteinuria in 37%. Liver function tests remained normal in all patients. While most patients demonstrated substantial recovery in renal function, a minority (21%) exhibited persistent impairment up to two years following delivery. Cesarean sections were performed in 74% of cases, predominantly due to fetal distress. Neonatal outcomes showed that 63% of infants were born with normal birth weight, and the mean gestational age at delivery was 35 weeks, with 57% of pregnancies reaching term. Of the 35 born neonates, admission to the neonatal intensive care unit was required in 9 (26%) with congenital anomalies observed in 1 (3%).

Pregnancy after kidney transplantation carries inherent risks but, with vigilant monitoring and multidisciplinary care, can achieve favorable outcomes. Although transient declines in renal function may occur, most patients in this study maintained stable long-term graft function. Maternal and neonatal complication rates remain higher than in the general population, highlighting the importance of individualized care and comprehensive preconception counseling.