title: Pregnancy after kidney transplantation: high rates of maternal complications.
abstract: BACKGROUND
  Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear.
  
  
  OBJECTIVE
  To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications.
  
  
  METHODS
  Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event.
  
  
  RESULTS
  There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001).
  
  
  CONCLUSIONS
  Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.
authors.affiliation: Centro Hospitalar de Setúbal, Setúbal, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Candido
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Marina Pontello
authors.initials: MP
authors.lastname: Cristelli
authors.affiliation: Centro Hospitalar de Setúbal, Setúbal, Portugal.
authors.forename: Ana Raquel
authors.initials: AR
authors.lastname: Fernandes
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Andre Caires Alvino de
authors.initials: AC
authors.lastname: Lima
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Laila Almeida
authors.initials: LA
authors.lastname: Viana
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Jussara L
authors.initials: JL
authors.lastname: Sato
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Sass
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Helio
authors.initials: H
authors.lastname: Tedesco-Silva
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Jose Osmar
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult