肾移植后妊娠 - 对母亲和移植物功能的影响及对儿童纵向发育的关注。
Pregnancy following kidney transplantation - impact on mother and graft function and focus on childrens' longitudinal development.
机构信息
Department of Nephrology and Medical Intensive Care medicine, Charité University medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany.
Department of Obstetrics and Gynecology, University Women's Clinic, University of Tuebingen, Calwerstrasse, 7, 72076, Tuebingen, Germany.
出版信息
BMC Pregnancy Childbirth. 2019 Oct 23;19(1):376. doi: 10.1186/s12884-019-2496-z.
BACKGROUND
Pregnancy after kidney transplantation has been considered as high risk for maternal and fetal complications. After careful patient selection successful pregnancies are described. Little is known about fetal outcomes and data is particularly scarce on childrens´ early development up to two years when born to kidney/-pancreas transplant recipients. Here, we analyzed maternal and fetal risk and evaluated graft function during pregnancy in transplanted women. We aimed to identify factors affecting the outcomes of mothers and their grafts during pregnancy and of children up to 2 years after delivery/ birth.
METHODS
All consecutive pregnancies in kidney/ kidney-pancreas recipients with live-born children from 2002 to 2016 were evaluated in two transplant centers (Charité Berlin/ University Tuebingen). All data was gathered from medical records. Impact of pregnancy on obstetrical risks, graft function and fetal development was evaluated. Additionally, for the first time development of children, including physical examination and assessment of neurological function were evaluated at 12 and 24 months.
RESULTS
Thirty-two pregnancies in 28 patients with a median duration of 34 gestational weeks (range, 24-38) were analyzed. 13 patients (46.4%) developed deterioration of kidney graft function > 10 ml/min during pregnancy. In majority, caesarean section was performed (75%). Twenty-five (78.1%) children were born prematurely, thereof (16%) < 28 weeks. Almost 70% had low birth weights (LBW) (< 2.500 g); median birth weight was 2.030 g. General health and physical constitution of children were unremarkable with normal development in 94% at 12 and 24 months of corrected age, respectively.
CONCLUSION
Despite the high rate of preterm birth and LBW, development up to two years was age-appropriate in this cohort. Due to low absolute numbers, increasing efforts in centralized counseling, diagnostics and committed specialist support are required. Decisive treatment of these high-risk patients in specialized units leading to better performance of these patients (mother/ fetus) is deemed superior. In order to confirm this, prospective studies on neonatal and pediatric outcomes with a standard-of-care comparator arm will be conducted.
背景
肾移植后的妊娠被认为对母婴并发症有较高的风险。经过精心的患者选择，成功妊娠的案例已有报道。然而，关于胎儿结局的数据相对较少，特别是在儿童出生后 2 年内的早期发育数据，这部分数据尤其缺乏。在这里，我们分析了移植女性妊娠期间的母婴风险和移植物功能，并旨在确定影响妊娠期间母亲及其移植物以及分娩/出生后 2 年内儿童结局的因素。
方法
我们在两家移植中心（柏林夏里特医院/图宾根大学）评估了 2002 年至 2016 年间所有连续接受肾/肾-胰腺移植并有活产儿的女性的妊娠情况。所有数据均来自病历。评估妊娠对产科风险、移植物功能和胎儿发育的影响。此外，我们首次在 12 个月和 24 个月时对儿童的发育情况进行了评估，包括体格检查和神经系统功能评估。
结果
分析了 28 例患者的 32 例妊娠，中位孕龄为 34 周（范围 24-38 周）。13 例患者（46.4%）在妊娠期间出现移植物功能恶化>10ml/min。多数患者行剖宫产（75%）。25 例（78.1%）患儿早产，其中 16%<28 周。近 70%的患儿出生体重低（LBW）<2500g；中位出生体重为 2030g。患儿的一般健康状况和体格均无异常，94%的患儿在 12 个月和 24 个月时的校正年龄时发育正常。
结论
尽管早产和 LBW 的发生率较高，但在本队列中，儿童在 2 岁时的发育仍与年龄相适应。由于绝对数量较少，需要加强集中咨询、诊断和专门支持。在专门单位对这些高危患者进行有决策的治疗，以改善这些患者（母亲/胎儿）的预后被认为是更好的选择。为了证实这一点，我们将开展新生儿和儿科结局的前瞻性研究，并设立标准护理对照臂。
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