title: Triplet Pregnancy in a Diabetic Mother With Kidney Transplant: Case Report and Review of the Literature.
abstract: Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus. The patient, a 31-year-female who received a living-donor kidney transplant, had a first-time pregnancy 6 years after transplant. Pregnancy was complicated by gestational diabetes, preeclampsia, and miscarriage. She continued to have postpartum-impaired glucose tolerance. She became pregnant again after 6 months but required insulin therapy during her third trimester. Pregnancy was terminated by cesarean section for a viable small boy. Two years later, she had triplet pregnancy after ovulation induction with clomiphene. Glycemic control was maintained using intensive insulin therapy guided by frequent home blood glucose monitoring (HbA1c was 5.8% at 22 wk). Both gynecologic care and nephrologic care were carried out through outpatient follow-up. Pregnancy was complicated by hypertension and mild renal dysfunction without proteinuria and ended in elective premature cesarean section at 32 weeks of gestation. She had 3 male babies with low birth weights (1320, 1380, 1275 g), with the largest baby developing sepsis and requiring an intensive care unit stay and then incubator for 49 days. The other 2 required incubators for 36 days. Their weights after 22 months were 9, 16, and 11 kg. The mother is now normotensive with normal renal function and impaired glucose tolerance. Care of diabetic kidney recipients with triplet pregnancy constitutes a special challenge requiring a multispecialty skilled team to ensure the best outcome.
authors.affiliation: Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait.
authors.forename: Tarek
authors.initials: T
authors.lastname: Mahmoud
authors.forename: Khalida
authors.initials: K
authors.lastname: Mujaibel
authors.forename: Hosam
authors.initials: H
authors.lastname: Attia
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Zakaria
authors.forename: Jude
authors.initials: J
authors.lastname: Yagan
authors.forename: Osama
authors.initials: O
authors.lastname: Gheith
authors.forename: Medhat Abdel
authors.initials: MA
authors.lastname: Halim
authors.forename: Prasad
authors.initials: P
authors.lastname: Nair
authors.forename: Torki
authors.initials: T
authors.lastname: Al-Otaibi
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D017558:Elective Surgical Procedures; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007231:Infant, Newborn; D007247:Infertility, Female / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007328:Insulin / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D059286:Pregnancy, Triplet; D027724:Reproductive Techniques, Assisted
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human