Pregnancy outcome in renal allograft recipients in Norway. The importance of immunosuppressive drug regimen and health status before pregnancy.

BACKGROUND

To study the influence of pre-conceptional health status and immunosuppressive drug regimen on pregnancy outcome in renal allograft recipients.

METHODS

The study includes all pregnancies in renal allograft recipients in Norway in the period 1973-1991. The data were collected from the patient records. Serum-creatinine values, proteinuria, blood pressure, recent graft rejection, and immunosuppressive drug regimen before pregnancy as well as the interval from transplantation until pregnancy were related to the frequency of deliveries at term, preterm deliveries, and of induced and spontaneous abortions.

RESULTS

54 pregnancies in 37 renal allograft recipients resulted in 31 term deliveries, 12 preterm deliveries, four spontaneous, and seven induced abortions. One induced abortion due to psychosocial reasons was excluded from the calculations. Post-transplant intervals less than two years as compared to longer intervals were associated with an increased frequency of spontaneous and induced abortions (6/13 vs 4/40, p < 0.01) and a non-significant increase in the relation between preterm and term deliveries (3/4 vs 9/27). The few women with proteinuria, elevated serum-creatinine values, and hypertension before pregnancy had an increased number of adverse pregnancy results. The women receiving cyclosporine A experienced a larger frequency of spontaneous and induced abortions (7/18 vs 3/35, p < 0.05) and an increase in the relation between preterm and term deliveries (7/4 vs 5/27, p < 0.01) as compared to the women who received prednisolone and azathioprine only.

CONCLUSIONS

The results demonstrate the importance of pre-conceptional consultation and may indicate a harmful effect of cyclosporine A on pregnancy outcome.