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 a nd immunosuppressive drug regimen on pregnancy outcome in renal allogr aft recipients. Methods. The study includes all pregnancies in renal a llograft recipients in Norway in the period 1973-1991. The data were c ollected from the patient records. Serum-creatinine values, proteinuri a, 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, p reterm deliveries, and of induced and spontaneous abortions. Results. 54 pregnancies in 37 renal allograft recipients resulted in 31 term de liveries, 12 preterm deliveries, four spontaneous, and seven induced a bortions. One induced abortion due to psychosocial reasons was exclude d from the calculations. Post-transplant intervals less than two years as compared to longer intervals were associated with an increased fre quency of spontaneous and induced abortions (6/13 vs 4/40, p < 0.01) a nd a non-significant increase in the relation between preterm and term deliveries (3/4 vs 9/27). The few women with proteinuria, elevated se rum-creatinine values, and hypertension before pregnancy had an increa sed number of adverse pregnancy results. The women receiving cyclospor ine A experienced a larger frequency of spontaneous and induced aborti ons (7/18 vs 3/35, p < 0.05) and an increase in the relation between p reterm and term deliveries (7/4 vs 5/27, p < 0.01) as compared to the women who received prednisolone and azathioprine only. Conclusions. Th e results demonstrate the importance of pre-conceptional consultation and may indicate a harmful effect of cyclosporine A on pregnancy outco me.