Pregnancy Outcomes Using Assisted Reproductive Technology in Kidney Transplant Recipients

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND: Infertility is common among those with kidney transplants, and pregnancy is associated with a high risk of adverse maternal and fetal outcomes. Little is known about the outcomes of pregnancy with assisted reproductive technology (ART) in women with kidney transplants. METHODS: This retrospective cohort study used data from the Transplant Pregnancy Registry International. Eligible participants were recipients of a kidney transplant between March 1968 and July 2022 who were aged 14 y or older at conception. Logistic regression analyses (adjusted for age at conception and race) were constructed to compare pregnancy outcomes with ART versus natural conception. RESULTS: There were 130 pregnancies using ART in 77 kidney transplant recipients. ART pregnancies, as compared with natural conception pregnancies, were associated with a higher adjusted likelihood of hypertension during pregnancy (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.06-2.32), higher adjusted likelihood of cesarean delivery (OR, 1.60; 95% CI, 1.02-2.51), and higher adjusted risk of preterm births <37 wk (OR, 2.07; 95% CI, 1.35-3.18). Pregnancies with ART, as compared with natural conception, had a lower median birth weight (2551 versus 2722.0 g), a lower median gestational age (36.0 versus 37.0 wk), and a higher proportion of neonatal deaths (4.4% versus 0.8%). No differences were observed in the adjusted likelihood of preeclampsia, gestational diabetes, miscarriages, live births, low birth weights, birth defects, or 2-y graft loss between ART and natural conception pregnancies. CONCLUSIONS: ART pregnancies are associated with a higher risk of preterm births, hypertension during pregnancy, and cesarean delivery compared with naturally conceived pregnancies. The likelihood of live births and 2-y graft loss did not differ.

ART may add risks in transplant pregnancies; leaves open causality and needs prospective data before practice shifts.