Increased Pregnancy Risks Identified for ART in Kidney Transplant Recipients

Women who have undergone kidney transplantation and subsequently conceive through assisted reproductive technology (ART) face elevated risks of pregnancy-related complications, according to a pivotal study published in the journal *Transplantation* on July 7, 2025. The research, conducted by Dr. Silvi Shah, an associate professor at the University of Cincinnati College of Medicine, highlights significant concerns related to hypertension, preterm birth, and cesarean deliveries among this population.

Historically, women with chronic kidney disease have experienced considerable fertility challenges, often necessitating ART for conception. While some women may conceive naturally after a kidney transplant, an increasing number rely on ART to achieve pregnancy. This study marks one of the first comprehensive assessments of pregnancy outcomes specifically among kidney transplant recipients utilizing ART.

The retrospective cohort study analyzed data from the Transplant Pregnancy Registry International, focusing on female patients aged 14 years and older who received kidney transplants between March 1988 and July 2022. The study compared pregnancy outcomes for 130 pregnancies conceived via ART against those conceived naturally, employing logistic regression analyses to adjust for variables such as race and age at conception.

Findings revealed that pregnancies resulting from ART were associated with a 57% increased risk of hypertension (odds ratio of 1.57), a 60% likelihood of cesarean delivery (odds ratio of 1.60), and more than double the risk of preterm birth (odds ratio of 2.07). Additionally, infants born to mothers who used ART had a median birth weight of 2,551 grams, compared to 2,722 grams for those conceived naturally.

Despite these alarming statistics, Dr. Shah emphasized that ART remains a viable option for women with kidney transplants, provided that they have stable kidney function and optimal health conditions. “It’s safe for women with kidney transplants to pursue ART, provided they have stable creatinine values, optimal immunosuppression, well-controlled blood pressure, and no recent episodes of rejection,” she noted.

The study also assessed other complications, finding that rates of preeclampsia, gestational diabetes, miscarriage, and live birth did not differ significantly between the groups. However, neonatal death rates were notably higher in the ART group at 4.4% compared to 0.8% for natural conception.

These findings underscore the need for healthcare providers to carefully counsel kidney transplant recipients considering ART. The data serves as a critical resource for informing reproductive choices and improving maternal-fetal outcomes. “Our study provides valuable evidence to guide physicians when counseling patients toward family-planning decision-making and the use of assisted reproductive technology,” added Dr. Shah.

The implications of this study are considerable, particularly as the number of women with kidney transplants desiring pregnancy continues to rise. As ART technologies advance, understanding the associated risks will be essential for optimizing patient care and ensuring healthy pregnancies and outcomes for both mothers and infants.

In conclusion, while the use of ART in kidney transplant recipients is associated with certain increased risks, it does not adversely affect long-term kidney function or live birth rates. Future research should focus on longitudinal follow-up of outcomes and further refine guidelines for the safe use of ART in this unique patient population.