title: Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center.
abstract: OBJECTIVE
  Renal and obstetric outcomes in pregnancy after kidney transplantation in Singapore were last studied in 2002. A review of these outcomes in Singapore is now timely following advances in transplant and obstetric medicine. The aim was to evaluate the renal and obstetric outcomes in pregnancy after kidney transplantation in a Singapore tertiary center.
  
  
  METHODS
  Kidney transplant recipients who underwent pregnancy after transplantation at Singapore General Hospital between January 2001 and December 2012 were identified. Data on demographics, comorbidities and clinical outcomes were collected.
  
  
  RESULTS
  There were 10 pregnancies identified in nine recipients. The median age of recipient at childbearing was 34.6 years (IQR, 32.8-36.8) and the median interval from transplantation to conception was 69 months (IQR, 38-97). There was no difference between the median pre-pregnancy estimated glomerular filtration rate (eGFR) (47.9 mL/min/1.73 m(2); IQR, 38.4-56.8) and median eGFR at time of last post-partum follow up (43.9 mL/min/1.73 m(2); IQR, 34.5-48.7, P = 0.549). Borderline allograft rejection occurred in one recipient (10.0%) 36 days after birth due to non-adherence to immunosuppressive medication, with subsequent allograft loss 37 months after birth. No mortalities were recorded during the study period. All the 10 pregnancies (100%) ended in singleton live births. Pre-eclampsia occurred in five pregnancies (50.0%), and there were seven (70.0%) preterm deliveries. The median gestational age was 35.4 weeks (IQR, 32.6-38.2) and the median birthweight was 2353 g (IQR, 1811-2648).
  
  
  CONCLUSIONS
  Post-transplantation pregnancies ended successfully with no significant worsening of allograft function, but they were associated with risks to both recipients and newborns.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Jia Liang
authors.initials: JL
authors.lastname: Kwek
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tey
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Liying
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Devendra
authors.initials: D
authors.lastname: Kanagalingam
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Terence
authors.initials: T
authors.lastname: Kee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012846:Singapore
keywords: kidney transplantation; pregnancy; pregnancy complication; pregnancy outcome; renal outcome; transplantation