Research suggests that approximately 1 in 50 women of childbearing age will want to try for a baby after successful kidney transplantation. Indeed, world-wide there have been many hundreds of successful pregnancies and to date in Cardiff we have had several happy mothers.
There are no specific reasons why a woman of childbearing age should not have a child after transplant. However, it is recommended that the decision is made carefully and after discussion with the transplant consultant.
Most women who have had babies after transplant have taken cyclosporin (Neoral) throughout their pregnancy. Unfortunately, the manufacturers of tacrolimus (Prograf) do not currently recommend pregnancy whilst on the medication, although this may change as more information on the drug becomes available. If you are taking tacrolimus and are considering pregnancy you should not be put off discussing the possibility with your consultant.
Following transplant, many people experience a return of libido (sex drive). Women of child bearing age recover normal menstrual cycle and fertility. However, pregnancy is not recommended until at least 1 year after transplant.
This is for two main reasons:
1. To allow kidney function to stabilise
2. To be able to taper the level of immunosuppressant drugs to a minimum as some of these drugs have the potential to harm the baby, notably steroids and azathioprine.
In addition, the extra time allows other problems to be sorted out if necessary, such as high blood pressure and diabetes.
Until things have settled down you should consider an appropriate form of birth control. You can discuss this with your doctors/nurses as the pill or IUD may be inappropriate.
Careful planning is essential. If you want to try for a baby let your transplant consultant know in plenty of time so that they can help you by sorting out your medication and plans can be made with your obstetric team to monitor your baby. Monitoring the baby in the womb is very important. Babies born to mothers with transplants are often premature and small but there is no reason why you should not have a normal delivery.
In addition your transplant consultant will want to keep a close eye on you throughout the pregnancy. There is an increased risk of kidney rejection together with rises in blood pressure and an increased risk of urinary infections associated with any pregnancy that may affect your kidney. Therefore, it will be necessary for you to have closer monitoring of your blood levels during pregnancy.
After the birth, breast-feeding is not recommended. This is because some of the drugs used in immunosuppression are found in breast milk.