Pregnancy, Fertility, and Babies after a Kidney Transplant

After receiving a transplant, your fertility (ability to have a child) can return quickly for both men and women. Especially for women, planning pregnancy in partnership with your healthcare team is very important to keep yourself, your kidney, and your baby healthy.

Many people with kidney failure want to know if they can have a baby after getting a kidney transplant. The good news is that having a baby after a kidney transplant is usually healthier and safer than while on dialysis. Male transplant recipients typically do not have any problems having a baby after transplant.

Female recipients should carefully plan a pregnancy with their transplant team. Female transplant recipients and their babies can do very well after transplant with the right care, which includes the transplant team and an obstetrician (OB) who focuses on high-risk pregnancies, also called a Maternal Fetal Medicine (MFM) specialist.

A successful pregnancy is most likely when your new kidney is working well and your medicines are stable. It is usually recommended to wait at least one year after your transplant. It is possible to become pregnant sooner, but the risks of pregnancy-related problems may be greater.

Talk to your transplant team if you are interested in having a baby after a kidney transplant. Depending on what caused your kidney disease and other personal health factors, there may be special issues to consider.

For men

Fathering a child after transplant does not appear to cause problems for the male recipient, the mother, or the child. Babies fathered by male transplant recipients are very similar to people without kidney problems. If you've been trying to father a child for a year or more without success, talk with your doctor. A routine fertility check may be helpful. Some medications that are used after a transplant can reduce a man's ability to father children. If you have a transplant and would like to father a child, talk with your doctor about your medications.

For women

Transplant patients who are sexually active and have not gone through menopause should talk to their medical team about birth control options to manage fertility and pregnancy. Your healthcare provider can recommend the type of birth control that should be used based on your health history and personal wants. Many women who have high blood pressure should not use "the pill" (oral contraceptives) since this type of medicine can raise blood pressure and increase the chance of blood clots. The diaphragm, sponge, and condom are usually acceptable types of birth control, especially when used with spermicidal creams, foams or jellies, as well as some IUDs (intrauterine device).

Before becoming pregnant, female transplant recipients should:

• Wait at least 1 year after having a transplant or until your kidney is working well
• Talk to your doctor about changing some of your anti-rejection medicines that can hurt the baby before you plan to get pregnant
• See an obstetrician (or OB, a doctor for women’s health and pregnancy) who specializes in high-risk pregnancies to talk about your plans. These specialists are also called Maternal Fetal Medicine (MFM) specialists. They are the best partner for helping you have a healthy pregnancy with a kidney transplant.
• Learn about the risks and benefits of breastfeeding. If you are interested in breastfeeding, it is very important to discuss the medicines you are taking with the high-risk OB. Some medicines can be passed through your breast milk and can be harmful to your baby.

Whenever possible, it is recommended that you avoid taking CellCept®, Myfortic® and their generic forms (Mycophenolate Mofetil and Mycophenolic Acid) in the six weeks before becoming pregnant and throughout your pregnancy. Before you become pregnant, your physician may change your medicines, so it's very important to speak with your healthcare team about your plans to grow your family.

In some cases, pregnancy may not be recommended because there is a high risk to you or the baby. Another reason is that there might be a risk of losing the transplant. It’s important to share your hopes and goals with your provider and work together to find the best path forward.

Pregnant female recipients will need close monitoring during pregnancy, especially for blood pressure and anti-rejection medicines. This means regular appointments and blood draws that happen more often as you get closer to your due date. As the baby grows and the mother gains weight, the amount of anti-rejection medicines will need to change, too. Some of your other medicines may also be changed during pregnancy.

Though many female recipients are able to have healthy pregnancies and babies, there are risks to think about before becoming pregnant. In a small number of cases, organ rejection has occurred during pregnancy. Women with kidney transplants also have a higher risk of some complications, like preeclampsia, which is a type of high blood pressure that only happens during pregnancy, and cesarean delivery.

Recipients whose kidneys aren’t working well before getting pregnant have a higher risk of problems. It’s important to keep in touch with your transplant team and a high-risk OB about your care and pregnancy.

Many anti-rejection medicines are generally safe for a pregnant woman and her baby, but there are a few that are not. The highest risks for the baby of a transplant recipient happen when a mother takes CellCept®, Myfortic® or their generic forms (Mycophenolate Mofetil and Mycophenolic Acid). With these drugs, there is both a higher chance the mother will miscarry and a higher chance that the baby will have birth defects. Talk to your transplant team about the risks and benefits of taking them during pregnancy. Women who are considering pregnancy while taking newer therapies, such as sirolimus, everolimus and belatacept, should know that there is not as much information currently available about if or how these medicines affect pregnancy.

Many patients choose to switch to safer medications during pregnancy. The riskier medications should be stopped at least six weeks (or more) before becoming pregnant. Your doctor will likely monitor your medicine levels and your kidney health after you've stopped, and let you know when it's safe to attempt pregnancy.

Other than medicines, babies of kidney transplant recipients have about a three times greater chance of being premature (born before 37 weeks) or having a low birth weight (weighing less than about five- and one-half pounds). Even with these risks, children are overwhelmingly reported to be healthy and developing well in the long term. Rare health or development problems have occurred, more likely due to prematurity or inherited disorders.

Breastfeeding

Breastfeeding is an option for patients who have had a kidney transplant. Most anti-rejection medicines are safe for babies, including tacrolimus, prednisone, azathioprine, and cyclosporine. Just like with pregnancy, it is important to talk to your healthcare team, especially a high-risk OB, about breastfeeding if it is something you are interested in.

Some women have reported having more than one baby after kidney transplant. As in first pregnancies, transplant recipients should have stable kidney function. A few recipients have even had successful twin and triplet pregnancies.

• How could this kidney transplant affect my ability to have children?
• Can we talk about my goals for my family?
• Have you ever supported a patient who has had a successful pregnancy? What other health providers do you work with?

• NKF Peers
• To support ongoing research about transplant, pregnancy, and the effects of anti-rejection medicines on fertility and pregnancy, men and women can register a pregnancy with Transplant Pregnancy Register International on their website or by calling 877-955-6877.