In patients with end-stage kidney disease, renal transplantation has been found to significantly improve reproduction in women of childbearing age (18-49 years). However, despite the significant improvements in renal transplants and obstetric care, renal transplant recipients are drastically more susceptible to adverse maternal, fetal and allograft function outcomes in comparison to their non-transplant counterparts.
Preeclampsia is a hypertensive, multi-system complication that occurs in 2%-8% of all pregnancies and is a major cause of both maternal and fetal morbidity and mortality worldwide. The diagnosis of preeclampsia is defined by the new onset hypertension after 20 weeks of gestation in a previously normotensive pregnant woman with one of the following new onset proteinuria, other evidence of maternal organ dysfunction, including renal insufficiency, liver dysfunction, pulmonary edema, cerebral abnormalities and thrombocytopenia. Preeclampsia has an increased prevalence in renal transplant recipients, with a reported incidence that is 5%-6% higher in post-transplant pregnancy when compared to non-transplanted pregnancy. An estimated 52%-69% of renal transplant recipients have pre-existing hypertension prior to pregnancy, increasing their risk of superimposed preeclampsia developed. Preeclampsia predisposes the mother and child to future complications such as diabetes, hyperlipidaemia, cardiovascular disease, graft failure and end-stage renal disease.
