Women who have previously had a kidney transplant and have enjoyed good health for a year to two years can, in general, safely go ahead and have children. Pregnancy and childbirth do not seem to affect a woman's health or the health of her kidneys.
However, a woman has a slightly lower chance of becoming pregnant after transplant.
While most pregnancies will be successful with a healthy birth, these pregnancies must be treated as high-risk, with close medical supervision.
The woman who has received a kidney transplant has a greater risk of infection, because of the immunosuppressive medications she must take. This can affect both mother and the unborn child.
These medications will also be an issue after birth, due to crossover into the mother's milk. Breastfeeding is not recommended for the well-being of the baby.
A woman on dialysis has lower odds of conceiving, or if she conceives, of coming to term. Her hormone levels are irregular, and so are her periods, making even the chance of conceiving less likely.
She is also less likely to have healthy eggs. If conception does occur, it usually ends in miscarriage or premature delivery.
Even healthy kidneys work hard during pregnancy. For kidneys already burdened with kidney disease and dialysis, the load become onerous.
The resultant higher blood pressure and the increase of waste products in the blood mean she will be retaining more fluid. Higher blood pressure restricts blood flow through the placenta.
It also puts the mother in jeopardy of pre-eclampsia (formerly known as toxemia of pregnancy). This can lead to premature delivery, and the mother is at risk of hemorrhage.
For the woman on dialysis who finds herself pregnant, there are things she can do to increase her chances of having a healthy baby.
The high blood pressure and the increase of waste products in the blood mean she will be retaining more fluid. Her dialysis treatments should be increased from three to six treatments a week.
A team of professionals will help her chances of a healthy pregnancy and delivery. This would include her doctor, an obstetrician, and a pediatrician. She also needs a kidney specialist (nephrologist), a dialysis nurse, and a dietitian who specializes in the needs of kidney patients (renal dietitian).
Special attention must be given to her diet to include more protein as well as supplements of vitamins and minerals, especially folate (folic acid) and iron.
Resources
Pregnancy and kidney dialysis
http://www.davita.com/dialysis/lifestyle/a/2063
Pregnancy and Kidney Disease
http://www.kidney.org/atoz/content/pregnancy.cfm
Pregnancy-info.net: Kidney Disease
http://www.pregnancy-info.net/kidney_disease.html
Pregnancy After Kidney Transplantation
http://cjasn.asnjournals.org/cgi/content/full/3/Supplement_2/S117
Pregnancy And Birth: Safe For Women With Kidney Transplants
http://www.sciencedaily.com/releases/2009/09/090924185529.htm
Pregnancy After Renal Transplantation
http://www.renalandurologynews.com/pregnancy-after-renal-transplantation/article/149153
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